Sociodemographic, Rationale Drug Use of Antiepileptic Drugs among Pediatric Patients with Epilepsy: A Prospective Study at a Tertiary Care Hospital

A study of Rationale use of Sodium valproate and Levetiracetam as monotherapy in pediatric patients with Epilepsy at tertiary care hospital

Background: Drug  utilization  studies   helps   in   the   understanding  of  drug    usage   among  patients,  as  well  as  the  socioeconomic  background  and  rational  use  of  antiepileptics  in  children  with  epilepsy.   Objective: The  primary  aim  of  this  article  is  to  examine  the  justification  for  utilizing  sodium valproate  and  Levetiracetam  as  monotherapy  in  pediatric  epilepsy  patients, as  well  as  drug  use  and  prescribing  patterns  for  various  kinds  of  epilepsy. Materials & Methods: Pediatric  epilepsy  patients under the age of 18 who visited the outpatient department, patients who were on sodium valproate, carbamazepine, or Levetiracetam monotherapy for at least 3 months after starting treatment. Demographic details, disease characteristics like type of epilepsy, onset and duration of episode, details of first attack, last attack, frequency and family history related to epilepsy comorbid conditions. Details on the treatment, such as the drug prescribed, the dose, the duration of the treatment, and the dosage, were noted. Magnetic resonance image (MRI) Brain, CT Brain, Electroencephalogram (EEG) was done in selected patients and noted.   Results: In this study we have total of 91 patients younger than 18 years of age confirmed with epilepsy receiving Sodium valproate, Levetiracetam as Monotherapy. Among them 70.3% were male and 29.6% were females. As per the recent Kuppuswamy scale 64.8% of the patients were from an urban background, whereas 35.1% were from a rural background. On analyzing socioeconomic status we found that 38.5% belong to upper middle class family.  Nearly 26 % of the patients were diagnosed with focal seizures and 25% with GTCS. Lesser percentage observed with Rolandic, myoclonic, complex partial, refractory epilepsy. Majority 53.8 % were on Sodium valproate among older AEDs. Among newer AEDs 29.6% of patients received Levetiracetam as monotherapy. Key words: Epilepsy, Sodium valproate, Levetiracetam, Monotherapy, Rational use  

DK, Chaudhary DG. A Comparative Study of Serum 25-Hydroxy Vitamin D Levels in Children with Seizures Receiving Monotherapy and Polytherapy

The association between serum 25-hydroxy vitamin D (25(OH)D) antiepileptic drugs (AEDs) and bone health in individuals with epilepsy has been recognized for more than 30 years. Several studies indicate an increased risk for bone loss in patients on antiepileptic medication as well as low levels of serum 25(OH)D. Patients on polytherapy AED are at a higher risk of adverse drug effects compared with those on monotherapy. The present study assessed serum 25(OH)D levels in children receiving AED and compares those children receiving monotherapy versus polytherapy. This is a prospective cross-sectional study conducted in a tertiary care hospital setting on children with seizures receiving AEDs for period of more than 6 months. Participants were enrolled in three groups: 25 children on monotherapy, 25 children on polytherapy, and 25 healthy controls. Serum 25(OH)D level was performed for all children and analyzed. Serum 25(OH)D levels were normal in 52%, insufficient levels in 43.3%, and deficient in 6.7% of children. Vitamin D level was insufficient in 40% of children receiving monotherapy and 52% receiving polytherapy AED. Vitamin D deficiency was present in 4% in monotherapy group and 16% in polytherapy group which was statistically significant (p-value 0.047). Vitamin D deficiency was higher in children receiving AED compared with normal controls. Vitamin D deficiency and insufficiency were higher in children on polytherapy. Our study emphasized the importance of monitoring vitamin D levels in children receiving AED to detect abnormalities in vitamin D levels.