Journal of Research in Pharmacy Practice

Abstract Objective: Epilepsy is a chronic neurological disorder that affects 0.5%–1% 
of children. 30%–40% of patients are resistant to current anti-epileptic drugs. 
Lacosamide (LCM) appeared to be effective, safe, and well tolerated in children 
and adolescents. This study was aimed to evaluate whether LCM could be an 
effective add-on therapy in children with refractory focal epilepsies. Methods: This 
study was conducted from April 2020 to April 2021 in Imam Hossein Children 
Hospital, Isfahan, Iran. We included 44 children aged 6 months to 16 years with 
refractory focal epilepsy (based on International League Against Epilepsy criteria). 
LCM was given in divided doses of 2 mg/kg/day, increasing by 2 mg/kg every 
week. The first follow‑up visit was 6 weeks later, when all patients had reached 
the therapeutic dose. Findings: The average age of the patients was 89.9 months. 
72.5% of children had focal motor seizures. Evaluation of percent change in seizure 
frequency and duration before and after treatment showed a 53.22% reduction in 
seizure frequency and 43.72% reduction in seizure duration after treatment. Our 
study group tolerated LCM well, with few side effects. Headache, dizziness, and 
nausea were common side effects. In line with other studies, none of the suspected 
risk factors could predict response to LCM treatment. Conclusion: LCM appears 
to be an effective, safe, and well-tolerated medication in children with uncontrolled 
drug-resistant focal epilepsy.

Abstract This study was performed to investigate whether levetiracetam should be preferred to carbamazepine as a treatment choice for benign childhood epilepsy with centro Temporal spikes (BCECTS), the most common partial epilepsy of childhood. Methods: This randomized clinical trial study included 92 children with rolandic epilepsy aged 4–12 years referred to the Pediatric Neurology Clinic at Imam Hossein Hospital, Isfahan, Iran, from April 2019 to January 2020. Patients were selected consecutively and randomly assigned to two study groups (levetiracetam and carbamazepine groups). Patients were followed and revisited every 2 months for 6 months after starting the medication. The frequency and duration of seizure attacks and drug side effects were recorded before treatment and in bi-monthly visits. Data were analyzed by SPSS software Version 24 using Mann–Whitney U- test and Friedman test. Findings: In our study, the seizure frequency decrease was not significantly different between the two groups; however, patients in both groups showed significantly lower seizure frequency in 2, 4, and 6 months of follow-up compared to starting time. After a follow-up for 6 months, one out of 47 (2.1%) patients using levetiracetam showed intolerance, resulting in changing the medication. In addition, two out of 48 (4.1%) patients in the carbamazepine group had skin rashes. No significant changes had been reported regarding the duration of seizure attacks in both groups after treatment. Conclusion: This study showed encouraging results for using levetiracetam, with acceptable results and fewer side effects for the treatment of children with BCECTS in Iran.

Abstract One of the main problems facing public health providers and administrators in many countries is ensuring the rational use of high-cost drugs. In this regard, on-going process of medication use evaluation can be considered as a useful tool. In this study, we evaluated certain usage aspects of a highly-cost medication, that is, recombinant growth hormone (GH).
Methods: This cross-sectional study conducted from August 2012 to August 2014. Children receiving GH ± gonadotropin releasing hormone (GnRH) analogs were included in the study. A researcher-designed checklist was developed to evaluate the GH utilization in these patients. Baseline demographic characteristics and background clinical and growth data, as well as any aspects of drug therapy including indications, dosing, monitoring, and discontinuation were collected from the patients' medical records.
Findings: Seventy children receiving GH entered the study, of which 23 patients (32.85%) received GH and GnRH analogs simultaneously. At the baseline, 67 children (95.7%) had GH stimulation test, whereas serum insulin-like growth factor-1 (IGF-1) levels were measured in 63 (90%) patients. Sixty-seven patients (95.71%) had thyroid function test, whereas bone age was determined in 68 children (97.14%). The mean ± standard deviation of GH dose for idiopathic short stature, GH deficiency, Turner's syndrome and born small for gestational age in our study was 0.22 ± 0.025 mg/kg/week, 0.23 ± 0.04 mg/kg/week, 0.22 ± 0.015 mg/kg/week, and 0.23 ± 0.02 mg/kg/week, respectively. Height and weight of all patients were followed every 3–6 months, regularly. Thirty patients were treated with GH for at least 1 year, of which thyroid hormones and IGF-1 levels were measured annually in 25 (83.33%) and 26 (86.66%) patients, respectively; while bone age was evaluated in 13 (43.33%) children, annually. GH treatment was discontinued in 15 patients (21.42%), while financial problem was the major reason.
Conclusion: Diagnostic tests and monitoring of height, weight, IGF-1 level and thyroid function was properly performed in this setting. However, a number of patients with ISS and Turner's syndrome were under-dosed.