Abstracts

Rationale: Epilepsy, the most frequent chronic neurological condition in childhood, is commonly managed through the usage of Antiseizure drugs (ASDs). With the availability of newer ASDs in the market, clinicians have access to a growing repertoire of ASDs. The public health care system in Hong Kong provides more 90% of secondary and tertiary health care services to the whole population. It has a liberal policy on ASD use with minimal limitation to the prescriptions. It would be of epidemiological value to study any change in local ASD prescription pattern in recent decades and to elucidate underlying reasons in the observed changes.

Methods: In this retrospective cross-sectional study, the central computerized database of public hospitals was employed to identify all pediatric patients with diagnosis of epilepsy with ASD prescription in both years of 2000 and 2019. All included patients had to be aged under 18 years, had a International Classification of Diseases-9 (ICD-9) coding of epilepsy and had been prescribed at least one ASD. The percentage of ASD use represented the number of individuals prescribed with that ASD over the total population of patients with epilepsy in that year. Changes in prescription pattern were analyzed.

Results: A total of 1565 patients in 2000 and 1016 patients in 2019 were analysed. In 2000, mean age was 8.22±5.297 years (45% female; 55% male), and 65% were on monotherapy. In 2019, mean age was 8.12±5.382 years, (46% female; 54% male), and 53% were on monotherapy. Comparing data between 2000 and 2019, there was a significant decrease in Valproate (VPA) prescription from 55% to 49% (p < 0.01), Carbamazepine (CBZ) prescription from 38% to 12% (p < 0.01), and Phenobarbital (PB) from 17% to 10% (p < 0.01). There were increases in prescription between 2000 and 2019 for Topiramate (TPM) from 5% to 10% (p < 0.01) and Clobazam (CLB) from 8% to 15% (p < 0.01). Levetiracetam (LEV) was not available in 2000 but recorded significant usage in 2019 at 48%. It became the most widely used new-generation ASD among children. Clonazepam (CLN) usage was similar at 6% in 2000 and 5% in 2019 (p=0.22); Phenytoin (PHT) also had similar usage at 12% in 2000 and 14% in 2019. Overall, there was an increase in proportion of multiple ASDs therapy of 35% in 2000 to 47% in 2019 (p < 0.01, 95%CI 8.22%-15.75%).