Abstract

Background and Aim:

Despite high burden and morbidity, pan-India data on patients’ profiles and how specialists treat various types of epilepsy are scarce. Hence, this survey.  

Methodology: A cross-sectional questionnaire-based survey was digitally conducted among 156 consenting neurologists and 41 neurosurgeons across India.

Results:

Respondents’ mean practice experience was ~11.2 years. They encountered more generalized (55.33%) than partial seizures (44.67%), with a clear male preponderance across both seizure types (61.4% and 72.60%, respectively). Most newly diagnosed cases (52.8%) belonged to the 10-25 age group. For generalized seizures, levetiracetam (47.20%) and sodium valproate (39.10%) were the most common choices among first-line monotherapy as well as first-line add-on drugs (28.4% and 25.8%, respectively, followed by clobazam – 16.80%). Clobazam (16.7%) and levetiracetam (15.2%) were the most preferred second-line adjuvants. In case of partial seizures, oxcarbazepine (50.8%) and levetiracetam (26.9%) were the drugs of choice as first-line monotherapy as well as add-on to it (35% and 18.7% respectively). Lacosamide (20.3%) and oxcarbazepine (15.2%) were second-line add-on options. In the special consideration sub-group of women with epilepsy, levetiracetam (81.2%) again outscored its alternatives, including lamotrigine (45.2%), oxcarbazepine (21.8%), and brivaracetam (16.7%).

Discussion:

Levetiracetam is a preferred molecule of both neurologists and neurosurgeons as a first-line monotherapy, as well as a first and second add-on to it. It is useful across epilepsy patient profiles – generalized, partial, and women. This is followed by valproate and clobazam (as first-line and its add-on and second add-on, respectively) for generalized epilepsy. In partial epilepsy, oxcarbazepine is preferred (as first-line and its add-on), besides lacosamide (second add-on). Indian specialists see more generalized than partial epilepsy, with a clear male preponderance in their day-to-day practice, suggesting possible healthcare inequities, with adolescents and young adults most frequently afflicted.

Conclusion:

The survey has provided insights into current usage and place in therapy of various antiseizure medications across India.