Antiepileptic drug utilization in children from 1997–2005—a study from the Netherlands

Abstract

Objective To investigate the utilization of antiepileptic drugs (AEDs) in Dutch children and compare this with guidelines on the treatment of epilepsy in children.Method From the Dutch Interaction Database (IADB.nl) we selected children aged 0-19 years who received at least one prescription for an AED (ATC-code beginning with N03A) between 1997 and 2005. We calculated cumulative incidences and prevalences per 1000 children per year, stratified by age-category, sex and type of AED, and the total number of months each patient received at least one prescription of AEDs, and we counted the number of person-months and AEDs prescribed. For each AED, proportions of person-months were calculated for monoand combination therapy. Kaplan-Meier survival analysis was used to analyse the duration of AED use, stratified by sex. Results The overall prevalence of the prescription of AEDs to children was constant at approximately 4.0 per 1000 children during the years of the study. The overall cumulative incidence from 1997-2005 was 0.67 per 1000 children. When stratified by age category or sex, there were no relevant differences in incidence or prevalence. Valproic acid was the most frequently prescribed drug, followed by carbamazepine and lamotrigine. In 20.3% of all personmonths, patients received combination therapy; of these, 34.2% received combination therapy for 3 person-months or less. The older AEDs were prescribed more often as monotherapy than combination therapy, in contrast with the newer AEDs, for which the opposite was true. The 50% survival probability (= time period when 50% of children had stopped using AEDs) was around 2 years, with a significantly lower discontinuation of treatment for girls than boys (P = 0.04). Conclusion The overall cumulative incidence of AEDs was determined to be 0.67 per 1000 children, and the prevalence 4.0 per 1000 children. The most frequently prescribed drug is valproic acid, followed by carbamazepine and lamotrigine. The prescribing of AEDs seems to be in conformity with the overall recommendations of the guidelines on the treatment of epilepsy in children.

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“…Carbamazepine is one of frequently used anticonvulsant drug used for treatment of the epilepsy, trigeminal neuralgia, bipolar disorder and seizure disorder in both children and adult 50,51 . The several sever side effect have been observed in patient taking carbamazepine such as lifethreatening cutacous adverse reaction, Hypersensitivity reaction, StevensJohnsonsyndrome(SJS) and toxic epidermal necrolysis(TEN) 52 .…”

Economic evaluation of anti-epileptic drug therapies with specific focus on teratogenic outcomes

“…About 0.5% of all teenage girls are using anti-epileptic drugs 1,2 . A considerable part of these girls are still using the same anti-epileptic drug when they wish to become pregnant, as switching is not considered to be easy and stopping often not an option.…”

Changing incidence of hyperammonemia in Japan from 2006 to 2013: expansion of new antiepileptic drugs reduces the risk of hyperammonemia

“…According to drug utilization studies performed in the UK at the primary care level from 1993 to 2008, prescription of PHT declined annually whereas use of LTG and LEV increased markedly [11,12]. Significant changes of the prescribing pattern were also observed after the introduction of new AEDs in Australia [13], Taiwan [14], and Europe [15][16][17][18]. However, there has been no investigation into whether changes of AED use affect the incidence of adverse events.…”