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

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.