Utilization of Anti-Seizure Medication (ASMS) and Seizure Control in Pediatric Epilepsy: A Retrospective Cross-Sectional Study in Oman
TL;DR
Dose adjustments, particularly dose increases, were associated with a higher frequency of adverse effects, and careful dose optimization may therefore be important to balance tolerability and seizure management.
Abstract
Objectives: Epilepsy is a chronic neurological disorder associated with substantial morbidity, reduced quality of life, and a considerable global healthcare burden. We aimed to assess anti-seizure medication (ASMS) utilization patterns, adherence levels, and factors influencing seizure control and adverse effects among pediatric patients with epilepsy in Oman. Methods: A retrospective cross-sectional study was conducted at Sultan Qaboos University Hospital (SQUH) between January 2023 and November 2024. A total of 305 pediatric patients aged 2–12 years receiving at least one ASMS with a minimum of two years of follow-up were included. Data were extracted from electronic medical records. Adherence was assessed using the Medication Possession Ratio (MPR). Statistical analysis was performed using SPSS. Results: Levetiracetam (68.52%) was the most prescribed ASMS, followed by sodium valproate (22.62%) and topiramate (8.52%). Adherence was observed in 54.68% of patients. Mean seizure duration decreased progressively across follow-up visits. Seizure control was achieved in 43% of patients. Patients without adverse effects had significantly better seizure control (56.2% vs. 10.2%, p < 0.001). Dose increases were associated with higher rates of adverse effects. Conclusions: Levetiracetam was the most commonly prescribed ASMS. Seizure type influenced drug selection. Adverse effects had a strong negative impact on seizure control, while adherence showed a limited association, indicating that managing side effects is crucial for effective treatment. Optimizing ASMS dosing and minimizing adverse effects are essential to improving outcomes in pediatric epilepsy. Dose adjustments, particularly dose increases, were associated with a higher frequency of adverse effects. Careful dose optimization may therefore be important to balance tolerability and seizure management. In this study, just over half of the patients evaluated (54.68%) were classified as adherent based on Medication Possession Ratio.