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Shortcomings in the pharmacotherapy of epileptic children in Bombay, India
S C Karande1, S S Dalvi, N A Kshirsagar
1Department of Paediatrics, Seth G.S. Medical College & K.E.M. Hospital, Parel, Bombay, India.
Insights
Therapeutic Drug Monitoring (TDM) in epileptic children revealed suboptimal drug levels in most. TDM is crucial for optimizing epilepsy treatment and improving outcomes in pediatric patients.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Epileptology
Background:
- Epilepsy affects a significant number of children, requiring effective management.
- Therapeutic Drug Monitoring (TDM) is essential for optimizing anticonvulsant therapy.
- Challenges exist in achieving therapeutic drug levels in pediatric epilepsy management.
Purpose of the Study:
- To evaluate the impact of TDM on anticonvulsant drug levels in epileptic children.
- To assess the effectiveness of TDM in improving treatment outcomes for pediatric epilepsy.
- To determine the need for TDM services in India.
Main Methods:
- Retrospective analysis of 108 epileptic children undergoing TDM.
- Assessment of plasma drug concentrations (phenytoin, phenobarbitone, carbamazepine) before and after TDM.
- Evaluation of follow-up data to determine treatment adherence and outcomes.
Main Results:
- A high percentage of children had suboptimal plasma drug levels at initial assessment.
- Only a small fraction of patients were advised to continue their original prescriptions post-TDM.
- Children with shorter epilepsy duration prior to referral showed better outcomes.
- A small proportion achieved probable seizure control after TDM.
Conclusions:
- Suboptimal anticonvulsant drug levels are common in epileptic children.
- TDM significantly impacts treatment adjustments and potentially improves outcomes.
- There is an urgent need to establish TDM clinics for pediatric epilepsy in India.
Abstract:
In 108 epileptic children referred for Therapeutic Drug Monitoring (TDM), 60 (56 per cent) had epilepsy for over 2 years. At first estimation among 79 (73 per cent) children on monotherapy, only three out of 23 on phenytoin, 20 out of 31 on phenobarbitone, and 15 out of 25 on carbamazepine had plasma levels within the therapeutic range. After TDM, only nine (8 per cent) were advised to continue the original prescription. Only 35 (32 per cent) followed up beyond 6 months and 15 (14 per cent) who benefited had a significantly shorter duration of epilepsy before referral (P < 0.001). Eventually, 12 (11 per cent) followed up beyond 2 years, and five (5 per cent) had achieved a probable cure. The study highlights the urgent need for setting up TDM clinics for epileptic children in India.