Seizure control with minimal antiepileptic drugs(AEDs) is important in children with epilepsy. Audit on prescription patterns among paediatric neurologists is helpful to improve choice of treatment options.

Objective: To describe patterns of AED prescriptions among paediatric neurologists.

Methodology: A prospective cohort study was conducted at 4 paediatric neurology clinics in Sri Lanka. Children (<12 years) with confirmed epilepsy, with a minimum of 1 year follow up by a paediatric neurologist were included. Parental history and clinical records were used to gather information. Epilepsy syndromes were classified according to ILAE 1989 classification.

Results:Two hundred and eighty were evaluated. The underlying epilepsy syndromes were symptomatic partial 52.9%, symptomatic generalized 21.9%, idiopathic focal 11.3% and idiopathic generalized 13.9%. Aetiologies were genetic in 1.5%, structural in 40.9% and unknown in 57%. In 267(95%) treatment was started as monotherapy. Sodium valproate was the commonest choice in 49.6%, Carbamazepine in 32.8%, steroids in 7.3% and other AED in 10.2%. In those who did not respond to first AED, second AED was tried as monotherapy in 20.8%. A third was tried as monotherapy in 1.5%.  At time of review only 38.7% continued on monotherapy. In those with polytherapy, 55.4% were on two AEDS.   29.8% on three and 14.9% on more than three. Epilepsy outcome was Modified Engel Epilepsy scale of 1 in 46% (monotherapy-70.8%:polytherapy -33.3%). All others experienced a lower outcome scale.

Conclusions: Majority of childhood epilepsies were commenced treatment with monotherapy, however polytherapy was required in many for optimum seizure control.