A retrospective study on the usage of antiepileptic drugs in Asian children from 2000 to 2009 in the largest pediatric hospital in Singapore

Tan, Wei; Kong, Sing Teang; Chan, Derrick; Ho, Paul C.

doi:10.1002/pds.3293

Cited by 13 publications

(10 citation statements)

References 17 publications

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“…Interestingly, neurologists prescribed second‐generation AEDs more often than primary care physicians did . Studies from Asia show that the older drugs such as carbamazepine and valproic acid are still more commonly prescribed than second‐generation AEDs, although the use of newer AEDs is increasing in some areas …”

Section: Psychosocial Diagnostic and Treatment Challengesmentioning

confidence: 99%

Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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This article reviews the burden of epilepsy in Asia, the challenges faced by people with epilepsy, and the management of epilepsy. Comparison is made with other parts of the world. For this narrative review, data were collected using specified search criteria. Articles investigating the epidemiology of epilepsy, diagnosis, comorbidities and associated mortality, stigmatization, and treatment were included. Epilepsy is a global health care issue affecting up to 70 million people worldwide. Nearly 80% of people with epilepsy live in low- and middle-income countries with limited resources. People with epilepsy are prone to physical and psychological comorbidities, including anxiety and depression, which can negatively impact their quality of life. Furthermore, people with epilepsy are at higher risk of premature death than people without epilepsy. Discrimination or stigmatization of people with epilepsy is common in Asia and can affect their education, work, and marriage opportunities. Access to epilepsy treatment varies throughout Asia. Although highly advanced treatment is available in some countries, up to 90% of people with epilepsy are not adequately treated or are not treated with conventional antiepileptic therapy in resource-limited countries. People in remote areas often do not receive any epilepsy care. First-generation antiepileptic drugs (AEDs) are available, but usually only in urban areas, and second-generation AEDs are not available in all countries. Newer AEDs tend to have more favorable safety profiles than first-generation AEDs and provide options to tailor therapy for individual patients, especially those with comorbidities. Active epilepsy surgery centers are present in some countries, although epilepsy surgery is often underutilized given the number of patients who could benefit. Further epidemiologic research is needed to provide accurate epilepsy data across the Asian region. Coordinated action is warranted to improve access to treatment and care.

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Section: Psychosocial Diagnostic and Treatment Challengesmentioning

confidence: 99%

Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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“…While a number of treatments have been developed for pediatric seizures, valproate is still heavily utilized in many pediatric populations around the world, with prescribing rates as high as 50% in Jordan [3], 40% in Singapore [4], 25% in India [5] and 22% in the US [6]. While valproate is known to have teratogenic effects on fetal development, the impact of pediatric exposure on neurobehavioral development has remained less clear [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of early postnatal exposure to valproate on neurobehavioral development and regional BDNF expression in two strains of mice

Bath

Pimentel

2017

Epilepsy & Behavior

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Valproic Acid (Valproate) has been used for over 30 years as a first line treatment for epilepsy. In recent years, prenatal exposure to valproate has been associated with teratogenic effects, limiting its use in women that are pregnant or of childbearing age. However, despite its potential detrimental effects on development, valproate continues to be prescribed at high rates in pediatric populations in some countries. Animal models allow us to test hypotheses regarding the potential effects of postnatal valproate exposure on neurobehavioral development, as well as identify potential mechanisms mediating observed effects. Here, we test the effect of early postnatal (P4-P11) valproate exposure (100mg/kg and 200mg/kg) on motor and affective development in two strains of mice, SVE129 and C57Bl/6N. We also assessed the effect of early valproate exposure on regional BDNF protein levels, a potential target of valproate, and mediator of neurodevelopmental outcomes. We found that early life valproate led to significant motor impairments in both SVE129 and C57Bl/6N mice. Both lines of mice showed significant delays in weight gain, as well as impairments in the righting reflex (P7–8), wire hang (P17), open field (P12 and P21), and rotarod (P25 and P45) tasks. Interestingly, some of the early locomotor effects were strain and dose dependent. We observed no effects of valproate on early markers of anxiety-like behavior. Importantly, early life valproate had significant effects on regional BDNF expression, leading to a near 50% decrease in BDNF levels in the cerebellum of both strains of mice, while not impacting hippocampus BDNF protein levels. These observations indicate that postnatal exposure to valproate may have significant, and region specific effects, on neural and behavioral development, with specific consequences for cerebellar development and motor function.

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“…A multinational study also showed that older AEDs were favored over newer AEDs in Italy, the Netherlands, and the UK in 2005 [7]. Older AEDs still remained the dominant epilepsy treatment in 2009 in Singapore [16], and only 22.2 % of patients used new AEDs in 2005-2009 in Hong Kong [15]. Only 16 % of the Fig.…”

Section: Older Versus Newer Aedsmentioning

confidence: 95%

“…In Singapore, valproic acid (comprising approximately 40 % of the total AED usage), carbamazepine, and phenobarbital were most commonly prescribed in 2000-2009. Among the newer AEDs, levetiracetam was most widely used, followed by topiramate and lamotrigine in 2009 [16]. A cross-sectional study performed in a tertiary teaching hospital in India in 2012 showed that valproic acid was the most commonly prescribed AED, followed by phenytoin [23].…”

Section: Utilization Of Individual Aedsmentioning

confidence: 99%

“…Several epidemiological studies have evaluated AED prescribing patterns in adult and pediatric populations and reported different trends in the use of second-generation AEDs [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Prescription patterns have been evaluated most actively in European countries [3-5, 7-13, 17-19], whereas few studies have reported on AED utilization in large pediatric epilepsy cohorts in Asian countries [15,16]. AED prescribing patterns, particularly with respect to newer AED use in children, vary among countries due to differences in health care systems, AED availability, medication costs, reimbursement systems, epilepsy treatment guidelines, prescribing habits, and other unknown reasons [7].…”

Section: Introductionmentioning

confidence: 99%

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