DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20222554
Published: 2022-09-28

Evaluating the prescription pattern of newly diagnosed epilepsy patients in India - a real-world observational study

Meera Kacha, Amit B. Jain, Nilanj Dave, Alok Chaturvedi, Ankita Shah

Abstract


Background: To determine the demographic details and management choices of anti-epileptic drugs (AEDs) for the newly diagnosed epilepsy patients in India.

Methods: This was a retrospective, observational study conducted among newly diagnosed epilepsy patients in India between Apr 2021 and Mar 2022. The demographic parameters, treatment given, adherence to treatment, and clinician’s global assessment for effectiveness and safety of management options were evaluated.

Results: Out of 20,343 patients, majority of the patients were aged between 31-50 years (54.5%), and 62.7% of them were males. Majority of the patients were diagnosed with focal epilepsy (72.2%). Migraine was the most common (28.3%) neuropsychiatric comorbidity among these patients followed by anxiety (19.7%), stroke (18.5%) and depression (11.2%); other commonly reported comorbidities were hypertension (38.27%), gastrointestinal disorders (25.39%), and diabetes (22.06%). Levetiracetam (49.6%) was the most commonly prescribed AED, followed by valproate (29.1%), oxcarbazepine (15.5%), clobazam (13.3%) and lacosamide (8%). With the prescribed AEDs, majority (91%) of the patients had decrease in seizure frequency, most (99.2%) patients had ‘good to excellent’ adherence to the therapy, and clinicians rated the efficacy and safety of prescribed drugs as ‘good to excellent’ in most (99.9%) patients.

Conclusions: Epilepsy was common in patients aged 30-50 years with male preponderance. Focal epilepsy was more prevalent. Overall levetiracetam was the most prescribed AED. Levetiracetam and valproate were the most prescribed AEDs among focal and generalized epilepsy respectively. AEDs were well tolerated by most of the patients.


Keywords


Epilepsy, AED, Comorbidities, Seizures

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References


Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54:185-91.

Santhosh NS, Sinha S, Satishchandra P. Epilepsy: indian perspective. Ann Ind Acad Neurol. 2014;17:S3.

Definition of Epilepsy 2014. International League against Epilepsy. Available at: https://www.ilae.org/guidelines/definition-and-classification/definition-of-epilepsy-2014. Accessed on 2022 Sep 16.

Satishchandra P, Santhosh N, Sinha S. Epilepsy: Indian perspective. Ann Indian Acad Neurol. 2014;17:3.

Banerjee TK, Ray BK, Das SK, Hazra A, Ghosal MK, Chaudhuri A et al. A longitudinal study of epilepsy in Kolkata, India. Epilepsia. 2010;51:2384-91.

Sharma S, Chen Z, Rychkova M, Dunne J, Lee J, Kalilani L et al. Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study. Epilepsia. 2020;61:445-54.

Meyer A-C, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bulletin of the World Heal Org. 2010;88:260-6.

Murthy J. New-onset focal epilepsy in adults: Antiepileptic drug treatment. Neurology India. 2017;65:78.

Baker GA, Jacoby A, Buck D, Stalgis C, Monnet D. Quality of life of people with epilepsy: a European study. Epilepsia. 1997;38:353-62.

Chu F. The antiepileptics: Drug choice in newly diagnosed epilepsy. Astrocyte. 2018;5:74.

Joshi R, Tripathi M, Gupta P, Gulati S, Gupta YK. Prescription pattern of antiepileptic drugs in a tertiary care center of India. Ind J Pharmacol. 2020;52:283-9.

French J, Kanner A, Bautista J, Abou-Khalil B, Browne T, Harden C et al. Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004;62:1252-60.

Glauser T, Ben‐Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C et al. ILAE treatment guidelines: evidence‐based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006;47:1094-120.

Nandi D, Ajmany S, Ganguli H, Banerjee G, Boral G, Ghosh A et al. Psychiatric disorders in a rural community in West Bengal-an epidemiological study. Ind J Psychiatr. 1975;17:87-99.

Raina SK, Razdan S, Nanda R. Prevalence of neurological disorders in children less than 10 years of age in RS Pura town of Jammu and Kashmir. J Pediatr Neurosci. 2011;6:103.

Mani K, Rangan G, Srinivas H, Kalyanasundaram S, Narendran S, Reddy A. The Yelandur study: a community-based approach to epilepsy in rural South India-epidemiological aspects. Seizure. 1998;7:281-8.

Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India I: Epidemiology and public health. Ann Indian Acad Neurol. 2015;18:263-77.

Radhakrishnan K, Pandian JD, Santhoshkumar T, Thomas SV, Deetha TD, Sarma PS et al. Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India. Epilepsia. 2000;41:1027-35.

Das SK, Biswas A, Roy T, Banerjee TK, Mukherjee CS, Raut DK et al. A random sample survey for prevalence of major neurological disorders in Kolkata. Ind J Med Res. 2006;124:163-72.

Li X, Sundquist J, Sundquist K. Socioeconomic and occupational risk factors for epilepsy: a nationwide epidemiological study in Sweden. Seizure. 2008;17:254-60.

Begley C, Basu R, Lairson D, Reynolds T, Dubinsky S, Newmark M et al. Socioeconomic status, health care use, and outcomes: persistence of disparities over time. Epilepsia. 2011;52:957-64.

Joseph N, Kumar GS, Nelliyanil M. Pattern of seizure cases in tertiary care hospitals in Karnataka state of India. Ann Indian Acad Neurol. 2013;16:347.

Kannoth S, Unnikrishnan JP, Kumar TS, Sarma PS, Radhakrishnan K. Risk factors for epilepsy: a population-based case–control study in Kerala, southern India. Epilepsy Behavior. 2009;16:58-63.

Goel S, Singh N, Lal V, Singh A. Knowledge, attitude and practices of students about first aid epilepsy seizures management in a Northern Indian City. Ann Indian Acad Neurol. 2013;16:538.

Ottman R, Lipton RB. Comorbidity of migraine and epilepsy. Neurology .1994;44:2105.

Clarke T, Baskurt Z, Strug LJ, Pal DK. Evidence of shared genetic risk factors for migraine and rolandic epilepsy. Epilepsia. 2009;50:2428-33.

Andermann F. Migraine-epilepsy relationships. Epilepsy Res. 1987;1:213-26.

Shyam Babu C, Satishchandra P, Sinha S, Subbakrishna D. Co-morbidities in people living with epilepsy: Hospital based case-control study from a resource-poor setting. Epilepsy Res. 2009;86:146-52.

Babu CS, Satishchandra P, Sinha S, Subbakrishna D. Co-morbidities in people living with epilepsy: hospital based case–control study from a resource-poor setting. Epilepsy Res. 2009;86:146-52.

Joshi V, Katiyar B, Mohan P, Misra S, Shukla G. Profile of epilepsy in a developing country: a study of 1,000 patients based on the international classification. Epilepsia. 1977;18:549-54.

Koul R, Razdan S, Motta A. Prevalence and pattern of epilepsy (Lath/Mirgi/Laran) in rural Kashmir, India. Epilepsia. 1988;29:116-22.

Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ. 2010;88:260-66.

Steinhoff BJ, Staack AM. Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience. Therap Adv Neurological Disorders. 2019;12:1756286419873518.

Indian Epilepsy Society. Guidelines for the Management of Epilesy in India. Available at http://clinicalestablishments.gov.in/WriteReadData/epilepsy-guidelines.pdf. Accessed on 02 Sep 2022.