Exploring the Correlation between Seizure Control and Serum Levels of Antiepileptic Drugs in Pediatric Patients with Epilepsy in Ethiopia: A Retrospective Cross-Sectional Study

Introduction : Antiepileptic drugs (AEDs) are frequently used to treat seizures; however, in settings with limited resources, the relationship between seizure control and the plasma levels of these medications in the paediatric population is still not well understood. Purpose : This study investigated this correlation, aiming to optimize treatment strategies and enhance the well-being of children with epilepsy. Methods : A retrospective cross-sectional design was employed in three Ethiopian hospitals from September 2021 to February 2022. Data from 81 participants were analysed, with a focus on sociodemographic and clinical characteristics and AED serum levels. Results : Boys composed 69.1% of the sample, with an average age of 8.56 ± 4.35 years. Generalized seizures were predominant (54.3%). TDM was performed for valproic acid (13.7%), phenytoin (11.7%), phenobarbitone (8.7%), and carbamazepine (1.3%). Post-TDM, 48% of the patients underwent therapeutic interventions. A chi-square test revealed no significant relationship between seizure control and AED concentration (p=0.920). Correlation analysis revealed a fourfold increase in the odds of poor seizure control with antiepileptic polypharmacy (AOR=4.162, p=0.046) and a sevenfold increase with increasing seizure frequency (AOR=6.711, p=0.027). Fisher's exact test indicated a significant correlation between TDM results and AED effectiveness for phenobarbitone, phenytoin, and valproic acid. The lack of a direct correlation between AED concentrations and seizure control emphasizes the multifactorial nature of epilepsy management. Conclusions : This study emphasizes the need for personalized treatment for pediatric epilepsy, considering factors such as seizure frequency and antiepileptic polypharmacy. This suggests that caution should be taken in antiepileptic polypharmacy and regular seizure frequency assessment. Further research is recommended for improved treatment guidelines.