An audit of prescribing pattern of anti-epileptic drugs with its effect on therapeutic drug levels and seizure control at a tertiary care public hospital – PubMed Black Hawk Supplements

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CONCLUSION: Individualising drug therapy and therapeutic drug monitoring for each patient, along with patient factors such as medication compliance, concomitant drug and disease history, and pharmacogenetic assessment, should be the ideal practice in patients with seizures for better seizure control.
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An audit of prescribing pattern of anti-epileptic drugs with its effect on therapeutic drug levels and seizure control at a tertiary care public hospital - PubMed

An audit of prescribing pattern of anti-epileptic drugs with its effect on therapeutic drug levels and seizure control at a tertiary care public hospital

Renuka Munshi et al. Ghana Med J. 2023 Sep.

Abstract

Objective: The study objective was to evaluate the prescription pattern and use of anti-seizure medications (ASMs) in patients with a seizure disorder and to evaluate if a change in the ASM dose had a beneficial effect on seizure control, observed through Therapeutic Drug Monitoring [TDM] level of ASMs.

Methods: Details of anti-seizure medications with their therapeutic levels in the blood of patients with seizure disorder were analysed.

Design: Hospital-based retrospective analysis of patient case records.

Settings: Therapeutic Drug Monitoring OPD of a tertiary care public teaching hospital.

Participants: Case records of 918 patients with seizure disorder from 2016-2021.

Results: Data of men (53%) and women (47%) aged between 18-75 years was assessed About 62% (566/918) of patients were on levetiracetam, the most frequently prescribed anti-seizure medication. Whenever the ASMs dose was increased or decreased based on TDM levels, it was associated with a significant increase in the frequency of break-through seizures [OR- 5 (95% CI: 1.28-19.46)]. However, significant seizure control was observed when the patients were on the same maintenance dose of the anti-seizure medication [OR- 0.2 (95% CI: 0.06-0.63)]. Whenever an additional new anti-epileptic drug was prescribed or removed from the pre-existing anti-epileptic medications, it did not significantly impact seizure control.

Conclusion: Individualising drug therapy and therapeutic drug monitoring for each patient, along with patient factors such as medication compliance, concomitant drug and disease history, and pharmacogenetic assessment, should be the ideal practice in patients with seizures for better seizure control.

Funding: None declared.

Keywords: anti-seizure medications; breakthrough seizure; epilepsy; therapeutic drug monitoring.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1

Single OPD Visit: Proportion of patients prescribed with various ASMs (2016-2021) [N=918 patients]

Figure 2
Figure 2

Year-wise prescribing data of anti-seizure medications (single OPD visit)

Figure 3
Figure 3

Multiple OPD Visits: Number of ASMs prescribed (2016-2021) Abbreviations: Leve- Levetiracetam, Val-Valproate, Cbz- carbamazepine, Phy- Phenytoin, Cloba- Clobazam, Oxcbz- Oxcarbazepine, Laco- Lacosamide, Lamo-Lamotrigine, Topi- Topiramate, Pbt- Phenobarbitone

References

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An audit of prescribing pattern of anti-epileptic drugs with its effect on therapeutic drug levels and seizure control at a tertiary care public hospital – PubMed