ANTIEPILEPTIC DRUG PRESCRIBING PATTERNS AND CLINICAL OUTCOMES IN PEDIATRIC SEIZURE DISORDERS: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN KASHMIR

Abstract

Background: Anticonvulsant prescribing in children must balance seizure control against the vulnerabilities of a developing brain, yet drug utilization data from paediatric epilepsy populations in the Kashmir valley remain scarce. Objectives: To describe the demographic, clinical, and etiological profile of children admitted with seizure disorders; to characterize antiepileptic drug (AED) prescribing patterns; and to determine short-term clinical outcomes at discharge and their association with therapy pattern and seizure category. Methods: This cross-sectional, observational study enrolled 200 children (<18 years) admitted with seizure disorders to a tertiary paediatric referral centre in Srinagar, following Institutional Ethics Committee approval (Ref. IRBGMC-SGR/Pharma/533). Structured, pretested proformas captured demographic, clinical, aetiological, investigational, and prescribing variables. Data were analysed in SPSS v26.0; categorical comparisons used the chi-square test, with p<0.05 considered significant. Results: Infants (≤1 year) formed the largest age group (36.0%), with a male predominance (59.0%, M:F 1.44:1) and a majority from lower-middle socioeconomic strata (70.0%). Epilepsy with acute symptomatic seizures accounted for 69.0% of admissions; structural brain abnormalities (31.5%) and idiopathic causes (31.0%) were the leading aetiologies. Levetiracetam was the most frequently prescribed AED (62.0%), followed by sodium valproate (49.0%); monotherapy was used in 56.0% of patients. A favourable outcome at discharge (seizure controlled or improved) was achieved in 89.0% of patients, and was more frequent with monotherapy than polytherapy (92.9% vs 84.1%) and in acute symptomatic seizures than epileptic encephalopathy (91.3% vs 80.0%). Conclusion: Levetiracetam-predominant, largely monotherapy-based prescribing in this Kashmiri paediatric cohort was associated with favourable short-term seizure outcomes, while epileptic encephalopathy and polytherapy subgroups showed higher rates of partial or poor discharge outcomes reflecting greater underlying disease severity. Underutilisation of EEG (54.0%) and neuroimaging (53.0%) represents an actionable diagnostic gap.