Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Abstract

The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received 295 Open Journal of Psychiatry monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.

Profile of People with Epilepsy seen at a Tertiary Hospital in North-West Nigeria

“…Fifty-two (50.5%) patients had focal seizure while fiftyone (49.5%) had generalized forms. Of these, 46 patients (44.7%) had generalized tonic clonic seizure (primarily generalized tonic clonic); followed by focal with impaired awareness (complex partial) in 33 et al, also reported similar trend in young people. This could be attributable to the prevalence of risk factors for epilepsy that occurs commonly in childhood or young people like traumatic brain injury, recurrent febrile convulsions and CNS infections like meningitis and encephalitis found to be 14.6%, 12.6% and 5.8%…”

“…Equally, recent studies also reported carbamazepine to be more frequently used than other 22,33 AEDs.…”