Prescription Patterns Of Antiepileptic Drugs Research Articles

Prescription Pattern of Antiepileptic Drugs in Different Types of Seizure Disorder in Children

Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. The incidence of epilepsy is highest during childhood, especially for children aged 0 - 14 years. The goal of the study is find out the prescribing pattern of antiepileptic drugs in different types of seizure disorder in children. An educational observational study was carried out among 55 samples in the In-patient Department of Pediatrics, in a tertiary care teaching hospital, Bangalore. The data was collected by using self-designed data collection form. All information’s were processed and analyzed by using Microsoft excel. In the present study, breakthrough seizures was the most commonly observed type of seizure followed by simple febrile seizure. The most commonly prescribed antiepileptic drug was levetiracetam, followed by clobazam in monotherapy. Majority of the patients were prescribed with monotherapy followed by dual therapy. Levetiracetam + Clobazam, Levetiracetam + Sodium valproate and Levetiracetam + Phenytoin was the most preferred combination. Drug use pattern of Antiepileptic Drugs was described based on WHO prescription indicators, which shows out of 55 sample size, average number of drugs per encounter was 0.5, 44% of injections were encountered, antibiotics prescribed were 0%, drug prescribed based on generic name were 54% and 93% of drug was encountered based on essential drug list. Antiepileptic prescribing in this study population was only 56% in accordance to the ILAE treatment guidelines for epilepsy.

Impact of meningioma surgery on use of antiepileptic, antidepressant, and sedative drugs: A Swedish nationwide matched cohort study.

BackgroundMeningioma is the most common primary intracranial tumor and surgery is the main treatment modality. As death from lack of tumor control is rare, other outcome measures like anxiety, depression and post‐operative epilepsy are becoming increasingly relevant. In this nationwide registry‐based study we aimed to describe the use of antiepileptic drugs (AED), antidepressants and sedatives before and after surgical treatment of an intracranial meningioma compared to a control population, and to provide predictors for continued use of each drug‐group two years after surgery.MethodsAll adult patients with histopathologically verified intracranial meningiomas were identified in the Swedish Brain Tumor Registry and their data were linked to relevant national registries after assigning five matched controls to each patient. We analyzed the prescription patterns of antiepileptic drugs (AED), antidepressants and sedative drugs in the two years before and the two years following surgery.ResultsFor the 2070 patients and 10312 controls identified the use of AED, antidepressants and sedatives was comparable two years before surgery. AED use at time of surgery was higher for patients than for controls (22.2% vs. 1.9%, p < 0.01), as was antidepressant use (12.9% vs. 9.4%, p < 0.01). Both AED and antidepressant use remained elevated after surgery, with patients having a higher AED use (19.7% vs. 2.3%, p < 0.01) and antidepressant use (14.8% vs. 10.6%, p < 0.01) at 2 years post‐surgery. Use of sedatives peaked for patients at the time of surgery (14.4% vs. 6.1%, p < 0.01) and remained elevated at two years after surgery with 9.9% versus 6.6% (p < 0.01). For all the studied drugs, previous drug use was the strongest predictor for use 2 years after surgery.ConclusionThis nationwide study shows that increased use of AED, antidepressants and sedatives in patients with meningioma started perioperatively, and remained elevated two years following surgery.

Prescription patterns of antiepileptic drugs for adult patients with newly diagnosed focal epilepsy from 2006 to 2017 in Japan

ObjectiveThis study aimed to examine prescription patterns of antiepileptic drugs (AEDs) for adult patients with newly diagnosed focal epilepsy in Japan and whether these patterns adhere to the 2010 Japanese Society of Neurology Guidelines of Epilepsy Treatment. MethodsData from the JMDC Claims Database were obtained for patients aged between 20 and 65 years with newly diagnosed focal epilepsy who were prescribed AEDs between 2006 and 2017. Available prescription information up to the patient’s first year was recorded and longitudinal descriptive statistics, Cochran Armitage Trend (CAT) tests, and annual percentage change (APC) were used to analyze AED trends and overall guideline adherence. In addition, logistic regression analyses were used to compare these results across different health facilities. ResultsA total of 6024 adult patients with newly diagnosed focal epilepsy were enrolled. The prescription of new AEDs increased significantly (CAT, p < 0.001, APC = 28.74 %) up to 36.8 % of all prescriptions in 2017 when compared to 2006. Among new AEDs, prescriptions for levetiracetam increased most rapidly and were followed by lamotrigine. In contrast, prescriptions for older AEDs, especially valproate, decreased over this same time period. The average guideline adherence rate from 2010 to 2017 was 75.3 %, and was not significantly different over time (CAT, p = 0.55). Health facilities with either more than 500 beds or between 20–499 beds had higher odds of prescribing new AEDs and improved guideline adherence when compared to facilities with 0–19 beds. ConclusionPrescription patterns of AEDs for adult patients with newly diagnosed focal epilepsy exhibited a trend from older to new AED classes between 2006 and 2017, with consistent, high guideline adherence from 2010 to 2017. Health facilities with 0–19 beds were less likely to prescribe new AEDs and completely adhere to proposed guidelines.

Prescription pattern of antiepileptic drugs in a tertiary care hospital

Background: Epilepsy is a chronic neurological disorder which affects about 0.5% to 1% of the population. The older antiepileptic drugs like carbamazepine and phenytoin are the mainstay of treatment of epilepsy. With the development of newer drugs for various type of epilepsy, the prescribing pattern for epilepsy has changed over the last decade. The objective of this study was to evaluate the prescription pattern of antiepileptic drugs in outpatient department of a tertiary care health care centre in Kerala and to assess how adherent they are to the available treatment guidelines of epilepsy.Methods: Data was collected from patients attending the outpatient department of Neurology in Government Medical College, Kozhikode for 2 months from January 2018 to February 2018. A total of 442 patients were enrolled in the study and data regarding the type of epilepsy, the antiepileptic drug prescribed, and the demographic profile were recorded and analysed.Results: Among the study participants, 237 were males (53.6%) and 205 females (46.2%). The study showed that among the 442 participants enrolled, the most common type of epilepsy was focal seizures (64.5%) and the most commonly prescribed drug was carbamazepine (28%), followed by levetiracetam (22%) and valproate (20%). Majority of the patients were treated with a single drug (79.2%).Conclusions: Newer drugs have been increasingly added to the list of antiepileptic drugs, but most of them serve as adjuvant to older ones and the important drugs used as monotherapy are still the older ones.

Prescription pattern of antiepileptic drugs in seizure disorders their adverse reactions, and cost analysis: A tertiary care hospital-based study

Background: Epilepsy affects 50 million people worldwide and approximately 10 million of these people live in India, but many patients with active epilepsy do not receive suitable treatment for their condition, leading to a large treatment gap. Aims and Objectives: This study was conducted to gather baseline information regarding the prescribing pattern of antiepileptic drugs (AEDs) for seizure disorders, adverse reactions, and cost analysis. Materials and Methods: It was a prospective study spanning 6 months (January 2019–June 2019), we analyzed the prescription data of 100 patients with seizures willing to give consent. Patients

Drug utilization pattern of anti-epileptic drugs in tertiary care hospital

Background: Epilepsy is a chronic neurological disorder that requires therapy over prolonged period of time to keep patient seizure free. Although patients respond with monotherapy, refractory epileptic patients require polytherapy. Drug utilization studies provide insight to rational drug prescribing. Aim and Objective: This study was designed to analyze and to study prescription pattern of antiepileptic drugs in patients with epilepsy in tertiary care hospital. Materials and Methods: The present study was conducted by collecting data from medical record department. Detailed data of patients diagnosed with epilepsy including demographic details, comorbidities, and allergies admitted from January 2015 to December 2017 in study pro forma were collected. Results: A total of 386 patient’s data were analyzed and it was found that male patients were most affected with epilepsy compared to females. Generalized tonic-clonic seizure (GTCS) was the most commonly diagnosed in majority of the patients. Levetiracetam (42.48%) was the most commonly prescribed drug as monotherapy, followed by phenytoin (11.91%), sodium valproate (8.54%), and carbamazepine (5.18%). The most common combination of drugs in polytherapy were levetiracetam and carbamazepine (12.43%), phenytoin with carbamazepine (8.03%), phenytoin with sodium valproate (7.21%), and phenytoin with lamotrigine (3.86%). Conclusion: The higher incidence of epilepsy is noted in males of all ages. GTCS was the most common type of epilepsy diagnosed and majority of the patients were prescribed with monotherapy. As it is a retrospective study, there were several limitations in the study such as quality of life of patients, compliance to the drugs, adverse reactions to the drugs were not assessed. Hence, further prospective studies with more sample size should be conducted to assess various factors on drug utilization in epilepsy.

Prescription pattern of antiepileptic drugs in a tertiary care center of India.

OBJECTIVES:The present study aimed to determine the pattern of prescription of antiepileptic drugs (AEDs) in a cohort of patients with epilepsy (PWE) attending a tertiary care center of North India.MATERIALS AND METHODS:Demographic variables including age, gender, age at onset, type and frequency of seizures, and prescription of all AEDs (dose and duration) were noted. Descriptive analysis of the use of AEDs was done, and their different combinations were studied.RESULTS:A total of 1187 prescriptions were evaluated. Demography showed 65.7% of males; mean age of 21.9 years (range: 2–77 years), generalized seizures (53%), and focal seizures (47%). Only 21.8% of the patients were seizure free with no seizure in 1 year of treatment. The five most frequently prescribed AEDs out of 12 AEDs were sodium valproate (VPA) (49.6%), clobazam (CLB) (39.3%), levetiracetam (LEV) (28.4%), carbamazepine (CBZ) (27.3%), and phenytoin (PHT) (26.5%). Monotherapy was effective in 36.6% of the patients. Sodium VPA (39.4%), PHT (25.6%), and CBZ (20.1%) were commonly used as monotherapy. Polytherapy was required in 63.4% of the patients, and most commonly prescribed combinations were PHT + CLB (n = 53), sodium VPA + CLB (n = 62), CBZ + CLB (n = 45), PHT + sodium VPA + CLB (n = 28), and CBZ + sodium VPA + CLB (n = 31).CONCLUSIONS:Polytherapy is a very common practice in our tertiary care center. Sodium VPA, a highly prescribed AED, results in good control of generalized seizures, whereas focal seizures are well controlled by CBZ alone as well as in combination. The present study highlights the commonly prescribed combinations of AEDs resulting in control of different types of seizures.

Prescription patterns of antiepileptic drugs in Kazakhstan in 2018: A retrospective study of 57,959 patients

AimThe goal of this retrospective study was to analyze prescription patterns of antiepileptic drugs (AEDs) in Kazakhstan in 2018. MethodsThis study used prescription data of patients with epilepsy who received AEDs in Kazakhstan in 2018. The outcome of the study was the prevalence of use of several AEDs (i.e., valproate, carbamazepine, lamotrigine, topiramate, levetiracetam) in these patients. Demographic variables included age and sex. The present study used descriptive statistics only. ResultsIn 2018, 57,959 patients with epilepsy with at least one AED prescription were found in the LRx database in Kazakhstan. The three most frequently prescribed AEDs were valproate (54.6%), carbamazepine (49.3%), and lamotrigine (16.8%). Interestingly, 10,745 valproate users were women aged ≤40 years. Monotherapy was more frequent than combination therapy and ranged from 80% in patients receiving topiramate to 90% in those receiving carbamazepine. The three most common combination therapies were valproate–carbamazepine (33.7%), valproate–lamotrigine (16.9%), and lamotrigine–carbamazepine (11.8%). ConclusionsPatients with epilepsy were frequently prescribed valproate, carbamazepine, and lamotrigine in Kazakhstan in 2018. Further research is needed to gain a better understanding of the prescription of valproate in women with epilepsy who are of childbearing age.

Prescription pattern of antiepileptic drugs in indoor patients at tertiary care hospital in Haryana, India

Background: Epilepsy is a challenging medical problem in India with an annual incidence of 27.27 per 100,000 population and prevalence of 572.8 per 100,000. People with epilepsy require prolonged treatment and monitoring. The main goal in the treatment of epilepsy should be adequate control of seizures, without causing any life-threatening reactions due to the medications. This study was done to get an insight into the prescription pattern of anti-epileptic drugs (AEDs) in different types of epilepsy.Methods: A prospective study was carried out for six months (Feb to June 2016) in admitted patients in super speciality ward (Lala Shyam Lal) in neurology department of PGIMS, Rohtak, Haryana. The prescription data of 100 patients of seizures was analysed.Results: Idiopathic generalised epilepsy was commonest type of epilepsy (42%) and sodium valproate was the commonest drug prescribed for its treatment (66.66%) followed by phenytoin (23.33%) Symptomatic epilepsy was second commonest seizure (30%) and phenytoin (60%) was the commonest drug prescribed for it followed by sodium valproate (30%). Common adverse effects associated with anti-epileptic drugs (AEDs) were nausea, drowsiness, weight gain, diplopia and ataxia.Conclusions: Idiopathic generalized epilepsy was the commonest type of epilepsy recorded and sodium valproate was the commonest prescribed drug.

Comparative study of antiepileptic drug use during pregnancy over a period of 12 years in Spain. Efficacy of the newer antiepileptic drugs lamotrigine, levetiracetam, and oxcarbazepine

IntroductionThe prescription pattern of antiepileptic drugs (AEDs) during pregnancy is changing but to what extent this is occurring in Spain remains unknown. The efficacy of newer drugs for controlling seizures is a key issue and may have changed over the years as doctors gained familiarity with these drugs during pregnancy. To assess these 2 topics, we report the results from the Spanish EURAP register gathered over a 12-year period. Material and methodsAfter signing informed consent forms, patients were included in the register and evaluated at onset of pregnancy, at the end of the second and third trimesters, after delivery, and one year after delivery. For the purposes of this study, we analysed AEDs, type of epilepsy, seizure frequency per trimester and throughout pregnancy, percentage of seizure-free pregnancies, and frequency of congenital malformations. We then compared data from 2 periods (June 2001 to October 2007 and January 2008 to May 2015). ResultsWe compared 304 monotherapies from the older period to 127 from the more recent one. There was a clear increase in the use of levetiracetam (LEV) with declining use of carbamazepine (CBZ), phenytoin, and phenobarbital; a slight decline in use of valproate (VPA), and a slight increase in the use of lamotrigine (LTG) and oxcarbazepine (OXC). Epilepsy types treated with CBZ and VPA remained unchanged, whereas fewer cases of generalised epilepsy were treated with LTG in the new period. This trend was not associated with significant changes in seizure frequency, but rather linked to better control over de novo seizures in the third trimester. LEV was similar to CBZ and VPA with regard to levels of seizure control, and more effective than LTG. Generalised epilepsy accounted for 64% of the cases treated with LEV. ConclusionsThe prescription pattern of AEDs during pregnancy has changed in Spain, with diminishing use of CBZ, phenytoin, and phenobarbital. Changes also reflect the type of epilepsy, since there is less use of LTG for generalised epilepsy. LEV provides similar seizure control to that of the older AEDs, and it is more effective and better than LTG.

Estudio comparativo del uso de fármacos antiepilépticos durante el embarazo en un periodo de 12 años. Eficacia de los nuevos fármacos lamotrigina, levetiracetam y oxacarbamacepina

IntroductionThe prescription pattern of antiepileptic drugs (AEDs) during pregnancy is changing but to what extent this is occurring in Spain remains unknown. The efficacy of newer drugs for controlling seizures is a key issue and may have changed over the years as doctors gained familiarity with these drugs during pregnancy. To assess these 2 topics, we report the results from the Spanish EURAP register gathered over a 12-year period. Material and methodsAfter signing informed consent forms, patients were included in the register and evaluated at onset of pregnancy, at the end of the second and third trimesters, after delivery, and one year after delivery. For the purposes of this study, we analysed AEDs, type of epilepsy, seizure frequency per trimester and throughout pregnancy, percentage of seizure-free pregnancies, and frequency of congenital malformations. We then compared data from 2 periods (June 2001-October 2007) and (January 2008-May 2015) ResultsWe compared 304 monotherapies from the older period to 127 from the more recent one. There was a clear increase in the use of levetiracetam (LEV) with declining use of carbamazepine (CBZ), phenytoin, and phenobarbital; a slight decline in use of valproate (VPA), and a slight increase in the use of lamotrigine (LTG) and oxcarbazepine (OXC). Epilepsy types treated with CBZ and VPA remained unchanged, whereas fewer cases of generalised epilepsy were treated with LTG in the new period. This trend was not associated with significant changes in seizure frequency, but rather linked to better control over de novo seizures in the third trimester. LEV was similar to CBZ and VPA with regard to levels of seizure control, and more effective than LTG. Generalised epilepsy accounted for 64% of the cases treated with LEV. ConclusionsThe prescription pattern of AEDs during pregnancy has changed in Spain, with diminishing use of CBZ, phenytoin, and phenobarbital. Changes also reflect the type of epilepsy, since there is less use of LTG for generalised epilepsy. LEV provides similar seizure control to that of the older AEDs, and it is more effective and better than LTG.

Prescription patterns of antiepileptic drugs in young women: development of a tool to distinguish between epilepsy and psychiatric disorders.

Antiepileptic drugs (AEDs) are also prescribed for therapeutic indications other than epilepsy (EPI), namely, psychiatric disorders (PSY). Our aim was to develop an algorithm able to distinguish between EPI and PSY among childbearing age women based on differences in AED exposure in these patient groups. Two groups of women (18-45 years) with EPI or PSY treated with AEDs in the first semester of 2010 or 2011 were extracted from paper or electronic medical charts of specialized centers. Through the prescription database of Bologna Local Health Authority (Italy), AEDs, treatment schedule and co-treatments were collected for each patient. A prescription-based hierarchical classification system was developed. The algorithm obtained was subsequently validated on internal and external data. Eighty-one EPI and 94 PSY subjects were recruited. AED monotherapy was the most common choice in both groups (69% EPI vs 79% PSY). Some AEDs were used only in EPI, others exclusively in PSY. Co-treatments with antipsychotics (6% vs 67%), lithium (0% vs 9%), and antidepressants (7% vs 70%) were fewer in EPI than in PSY. The hierarchical classification system identified antipsychotics, SSRIs (Selective Serotonin Reuptake Inhibitors), and number of AEDs as variables to discriminate EPI and PSY, with an overall error rate estimate of 9.7% (95%CI: 5.3% to 14.1%). Among the differences between EPI and PSY, prescription data alone allowed an algorithm to be developed to diagnose each childbearing age woman receiving AEDs. This approach will be useful to stratify patients for risk estimates of AED-treated patients based on administrative databases. Copyright © 2016 John Wiley & Sons, Ltd.

A Study of Prescription Pattern of Anti-epileptic Drugs in District Hapur, Uttar Pradesh

A Study of Prescription Pattern of Anti-epileptic Drugs in District Hapur, Uttar Pradesh

Trends in Antiepileptic Drug Prescriptions for Childhood Epilepsy at a Tertiary Children's Hospital in Korea, 2001-2012.

Longitudinal prescription patterns of antiepileptic drugs (AEDs) have not been described to date in Korea. Here we aimed to describe AED prescribing trends over a 12-year period and assess age differences in AED prescribing patterns in a pediatric epilepsy population. We retrieved and analyzed all AED prescribing and dispensing data in 2001-2012 in patients aged 0-18 years with an established diagnosis of epilepsy at the largest tertiary children's hospital in Korea. AEDs included for analysis were classified as older (i.e., carbamazepine, ethosuximide, phenobarbital, phenytoin, and valproic acid) and newer (i.e., gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate, vigabatrin, zonisamide, lacosamide, and rufinamide) on the basis of market availability before versus after 1991. A total of 5593 patients with epilepsy were prescribed an AED during the 12-year period. The proportion of newer AED prescriptions was 52.6 % in 2001 and continuously increased to 74.3 % in 2012. Oxcarbazepine was most widely used, followed by valproic acid. While carbamazepine and vigabatrin use progressively decreased over the 12-year period, those of lamotrigine and topiramate rapidly increased. Age differences in prescribing patterns were observed. Polytherapy was observed in 49.7 % of the total population, while 83.9 % of new users were prescribed monotherapy. This study provided updated information on AED prescription trends for childhood epilepsy. We found a progressive increase in the use of newer AEDs. However, valproic acid, the only prevalent older AED, continued to be widely prescribed. A high rate of polytherapy among the prescriptions overall raises some safety concerns.

Prescription patterns of antiepileptic drugs in patients with epilepsy in a nation-wide population

Many new antiepileptic drugs (AEDs) have become available in recent years. Investigations of prescription patterns and exposure of AEDs to different patient groups are important regarding drug safety aspects. The aim of this study was to investigate the use of AEDs in epilepsy, with focus on exposure of AEDs, gender and age differences and changes in prescription patterns over time. The data consisted of all prescriptions of AEDs from Norwegian pharmacies from the Norwegian Prescription Database (NorPD) (2004-2009), which included 44,000-47,000 patients with epilepsy each year. Variables included age, sex, diagnosis-related reimbursement codes and the use of AEDs (defined daily doses (DDDs)). Twenty two AEDs were in use. There were pronounced age- and gender differences regarding the use of AEDs in epilepsy. The most commonly used drugs were valproate and lamotrigine in children, carbamazepine and lamotrigine in adults, and carbamazepine and phenobarbital in the elderly. Lamotrigine and topiramate were predominantly used in female, and valproate and carbamazepine were predominantly used in male patients, respectively. Eighteen percent used polytherapy with AEDs. Of patients using lamotrigine, 14% received different generic preparations, in spite of the policy of restricted generic substitution. The use of AEDs in 2009 was 6.6 DDDs/1000 inhabitants/day, 49% of the use covered newer AEDs. The use of AEDs in epilepsy (2004-2009) was investigated in detail. All AEDs showed pronounced age and gender differences. Newer AEDs covered 49% of the total use in 2009. The study contributes to pharmacovigilance, as it offers a basis of knowledge for national decision-making authorities in the field of drug utilization.