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EVALUATION OF PRSCRIBING PATTERN OF ANTIEPILEPTIC DRUGS IN EPILEPSY


A.Srinivasan*, T.Venkatachalam, N.Senthilkumar, K.C.Arulprakasam, P.S. Athmaja Krishna
Department of Pharmacy Practice, JKKMMRFs AJKKSA College of Pharmacy, Komarapalayam, Tamilnadu.

ABSTRACT

Aim/objective This study was to assess the drug prescription pattern of anti epileptic drugs in epilepsy.

Methods The perspective observational study was carried out at epilepsy clinic of the government general hospital Chennai – 3, on August 2004 ­– January 2004. 485 patients were enrolled in this study, following data were collected from patients prescriptions that demographical data, types of epileptic disorder and types of anti epileptic drugs used in patients.

Results and conclusions The age wise distribution of the patients is maximum numbers of patients were in the age groups 11 -20 & 21-30. 69 % patients suffered by GTCS followed by 13 % patients were in complex partial seizure, 8 % patients were with simple partial seizure 4% patients were with Focal seizure and 4% patients were with myoclonic seizure . 51% of patients were receiving single drug therapy and 48% of patient was receiving multiple drug therapy. In GTCS 44 % of patient receiving single drug therapy followed by 33% of patient receiving two drugs, 9% of patient receiving three drugs. In single drug therapy Phenytoin prescribed to 32 % patient. Phenytoin with Carbamazepine combination was widely used in GTCS. In Focal seizure 80 % patient receiving  single drug therapy , 19 % patient receiving two drugs .

In single drug therapy Carbamazepine goes first choice to  prescribe.  In Myocolnic seizure  60 % patient receiving single drug therapy , 40% patient receiving two drugs . In single drug therapy carbamazepine was most widely prescribed 50 % patients. In two drug therapy carbamazepine with sodium valporate was most widely prescribed. In simple partial seizure 36 %  patient received single drug therapy , 48% received two drug therapy , 14 % patients received three drug therapy . In three drug therapy Phenytoin was combined with Carbamazepine and sodium valporate / sodium valporate and phenobarbitone . In complex partial seizure 49 % patient received single drug therapy, 43% two drug therapy, 7 % patient received three drug therapies.

The goal of treatment in patients with epileptic seizures is to achieve a seizure free status without adverse effect . Monotherapy was a desirable because it decreases ADR and drug interactions . But older anticonvulsant agents have hepatic enzyme inducing properties that decreases the serum level of the contaminant drug , thereby increasing the required dose of the concomitant drug . People with seizures experience psychosocial adjustments after their diagnosis. Therefore social and vocational rehabilitations may be needed.

Key words:  Pattern, Antiepileptic Drugs, Epilepsy, Phenytoin, Carbamazepine.  

INTRODUCTION

Epilepsy is the 4th most common chronic neurologic condition managed by neurologist. It is estimated that there are 55, 00,000 persons with epilepsy in India. Epilepsy and seizures are more common in young children’s and elders. 1 in 26 people will develop epilepsy in their lifetime. Age, missed medication, lack of sleep, psychological stress, and flash light are some of common risk factors in epilepsy. Although the different types of epilepsy vary greatly, in general, medication can control seizures in about 70% of patients

The choice of drug is most often based on factors like patients tolerance; The goal of treatment in patients with epileptic seizures is to achieve a seizure free status without adverse effect. Seizure medication are available in two types : narrow and broad spectrum AEDs . Some patients may need more than one medication to prevent the epileptic seizures more effectively.

NARROW SPECTRUM AEDs

Narrow spectrum AEDs are designed for specific types of seizures. These are most appropriate medications if seizures occur in one specific part of the brain on regular basics. For e.g. Carbamazepine, Diazepam, Ethosuximide, Phenobarbitone , Phenytion .

BROAD SPECTRUM AEDs

Patients have more than one type of seizure , a broad spectrum AED may the best choice of treatment . These medications are designed to prevent seizures in more than one part of the brain, as opposed to the focalized effects of narrow spectrum AEDs. For e.g., Lorazepam, Primidone, onisamide, Vlporic acid.

Objective

  • To assess the AEDs prescribing pattern in epileptic drugs .
  • To assess the prevelance of different types of epilepsy in Epilepsy patients .
  • To assess the drug regimen (single / multiple AEDs) used in patients.

METHODOLOGY

  • Study design:  A perspective observational study
  • Study site:  The study was conducted in the epilepsy clinic in the institute of neurology, Government general hospital, Chennai-3.
  • Study duration: 6 months.

Inclusion criteria

  • More than 15 years of age.
  • Both sexes male and female.
  • Idiopathic epilepsy.
  • More than 6 months of antiepileptic drugs taken patients.

Exclusion criteria

  • Epilepsy due to secondary causes.

The data collecting format had framed based on study need, it includes demographical details of patients and types and duration of illness and details of different classes of anti-epileptic drugs prescribed to the patients.

Among 504 prescriptions were analysed, 485 prescriptions which fulfilled the above criteria were recorded in the Performa in the annexure, at the end of the  study, the data were analyzed.  

RESULTS

Sex wise distribution

Out of 485 patients, 252 patients were male and 233 patients were female.

Fig: 1 Sex wise distribution

Age wise distribution

The age wise distribution shows Maximum number of the patients was 11-20 and 21-30.

Fig: 2 Age wise distribution

Types of seizure

Chart shows 3 shows that out of 485 patients 338 were suffered from GTCS, 21 patients were suffered from focal seizure, 20 patients were suffered from myoclonic seizure, 41 were suffered from simple partial seizure and 65 were suffered from complex partial seizure.

Fig: 3 Types of seizure

Drug Therapy For Different Types Of Epilepsy

Table: 1 Drug therapy for different types of epilepsy

Types of Epilepsy Single drug No. of patients Two drugs No. of patients
GTCS Phenytion

Carbamazepine

Sodium valporate

Phenobarbitone

126

30

 

6

10

Phenytion + Carbamazepine

Carbamazepine + Sodium valporate

Carbamazepine + Phenobarbitone

Phenytion + Sodium valporate

Phenobarbitone + Sodium valporate

38

19

 

9

 

39

 

40

Focal seizure Phenytion

Carbamazepine

Sodium valporate

Phenobarbitone

3

7

4

3

Phenytion + Carbamazepine

Carbamazepine + Sodium valporate

Phenytion + Sodium valporate

Phenobarbitone + Sodium valporate

1

1

 

1

 

1

Myoclonic seizure Carbamazepine

Sodium valporate

10

 

2

Carbamazepine + Sodium valporate

Phenytion + Sodium valporate

5

 

3

Simple partial seizure and Complex partial seizure Phenytion

Carbamazepine

Sodium valporate

Phenobarbitone

2

7

4

 

2

Phenytion + Carbamazepine

Carbamazepine + Sodium valporate

Carbamazepine + Phenobarbitone

Phenytion + Sodium valporate

Phenobarbitone + Sodium valporate

4

6

 

5

 

3

 

2

 Drug Regimen

Out of 485 patients 248 (51.13%) patients had single drug therapy, 237 (48.87%) patients had Double dose therapy.

Fig: 4 Drug regimens

Drug Therapy for Different Types of Epilepsy

Fig: 5 Drug therapies for different types of epilepsy

The results shows that out of 485 patients in GTCS 172 patients had received single drug regimen, 129 patients had received two drug regimen, 37 patients had received three drug regimen. Likewise in Focal seizure 17 patients had received single drug and 4 patients had received two drug regimen. In Myoclonic seizure 12 patients had received single drug and 8 patients had received two drug regimen. In simple partial seizure 15 had received single, 20 had received two drugs, 6 had received three drug regimen. And complex partial seizure 32 had received single drug, 28 had received two drugs, 5 had received three drug regimen.

CONCLUSION

Epilepsy and seizures are more common in young children’s; Mono therapy was a desirable because it decreases ADR and drug interactions. The side effect depends on the dose, type of medications and length of treatment. The side effects are usually more common with higher doses but AEDs are usually started with lower doses and increased gradually one of the best rule in medicine is ‘‘go low and go slow’’  The prescription pattern of anti-epileptic drugs in the epilepsy clinic was similar to the recommended guidelines for the treatment of epilepsy .But older anticonvulsant agents has hepatic enzyme inducing properties that decrease the serum level of the contaminant drug, thereby increasing the required dose of the concomitant drug. People with seizures experience psychosocial adjustments after their diagnosis. Therefore social and vocational rehabilitations may be needed.

REFERENCES

  • Epilepsy: A comprehensive text book. Volume I edited by J. Engel. JR and T.A Pedley. Lippincorr-Raven publishers, Philadelphia 1997; 1, 2, 37, 47, 48.
  • Goodman & Gilman’s: Th pharmacological basis of therapeutics 10th edition, edited by Joel, G.Hardman, Lee E, Limbird.
  • Consulting Editor Alfred Goodman Gilman. McGraw Hill Medical division 2001; 528-537.
  • epilepsy.com [cited 2016, June 9]
  • mayoclinic.org [cited 2016, June 10]
  • m.webmd.com/a-to-z-guides/treating-epilepsy [cited 2016, June 12]