Polytherapy in pediatric patients with seizure disorder: diagnostic difficulties and prescription dilemmas

Background: Epilepsy is among the most common paediatric neurological conditions. Anti-seizure medications (ASMs) form the cornerstone of seizure management. Understanding current prescription patterns is vital for improving outcomes.Materials and Methods: A descriptive observational study was conducted at a tertiary care hospital over 20 months. Children aged 1–18 years on ASMs were enrolled. Data on epilepsy classification, ASM regimen, diagnostic support, and treatment compliance were collected. Statistical analysis was done using SPSS v23.Results: A total of 97 patients were included; 54.6% were male, and the mean age was 7.63 ± 3.47 years. Generalized seizures (54.5%) were more common than focal seizures (45.3%). Sodium valproate (38.1%) was the most frequently prescribed first-line ASM. Monotherapy was administered in 54.6% of patients and 45.4% received polytherapy. Notably, in most polytherapy cases, second or third drugs were added before optimizing the dose of the preceding ASM. Adverse drug reactions were reported in 51.5% of patients, more frequent among polytherapy recipients (p < 0.001).Conclusion: ASM prescribing in paediatric epilepsy is often a challenging task, with underutilization of diagnostic tools, lack of seizure specific ASM prescription and premature polytherapy. Wider use of diagnostic modalities, video recording of a seizure episode for precise classification and step-wise approach for dose optimization can reduce polytherapy, improve outcomes, and minimize side effects.