Assessment of Effectiveness of Antiepileptic Drugs under BNF Vs Regular Practice in Paediatric Age Group with Epilepsy: A Pilot Study

Introduction: Epilepsy is considered as the most common neurological disorder. Aim: To compare the effectiveness of Antiepileptic Drugs (AED) under British National Formula (BNF) guidelines and regular practice for different oral antiepileptic medications in enhancing and controlling the patient’s disease state and tolerability. Materials and Methods: The prospective longitudinal cohort study was conducted at Department of Paediatrics of DR. B.C. Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, between May 2018 and April 2019 where all the patients (70) were randomly divided into two groups; group I patients were on regular practice medication while group II patients followed BNF guidelines. The doses of the treatment plan was formulated and changed according to the subsequent follow-up. The formulation of doses was done by either increasing the current AED or adding a new AED to the treatment regimen. The Paediatric Quality of Life Inventory (PedsQL) was used to assess the adverse effects in epileptic patients. The data was analysed by using Microsoft Excel database and Statistical Package for the Social Sciences (SPSS) Version 21.0 was used for data computation, p-value< 0.05 was considered as statistically significant. Results: About 23.5% patients of group II had seizures whereas, 53.1% patients of group I had convulsions after six months follow-up. Patients on levetiracetam 10 mg/kg once daily then increased in steps up to 10 mg per kg twice daily (max. per dose 30 mg/kg) monotherapy were experiencing poor seizure control with a number of seizure incidence in group I patients (n=10) compared to patients (n=4) who followed the BNF guidelines. Adverse effects of AEDs such as headache, skin rash, weight loss, weight gain, diarrhoea, dizziness etc., were more in 53.12% patients of group I following regular practice medicines (n=17) compared to 23.5% patients (n=8) of group II followed BNF guidelines. In normal procedure for physical, physiological and overall functioning, there was a decrease in the PedsQL score of group I patients; while in BNF recommendation for physical, physiological and overall functioning, there was an insignificant difference in the PedsQL score of group II patients. Conclusion: The present study concluded that unbiased individualisation of patients for the selection AEDs and its doses according to BNF guidelines has been found to be significantly effective in reducing the adverse effects as well as improved seizure control in paediatric population.