Analytical Study of Adherence to Antiepileptic Drug Guidelines Among Prescribers in Kano State Teaching Hospital

Evidence-based prescribing of antiepileptic drugs is central to achieving optimal seizure control and minimising adverse effects, yet prescriber adherence to current international and national epilepsy treatment guidelines in Nigerian teaching hospitals has not been comprehensively analysed. This study analytically assessed adherence to antiepileptic drug prescribing guidelines among neurologists, psychiatrists, and general physicians at Aminu Kano Teaching Hospital in Kano State, North West Nigeria. A retrospective prescription analysis combined with a prospective prescriber survey was employed. Prescription data for 240 outpatients and inpatients with epilepsy diagnoses over 12 months were reviewed against the International League Against Epilepsy treatment guidelines and Nigeria's Essential Medicines List criteria. A structured questionnaire administered to 45 prescribers assessed guideline awareness, knowledge of preferred agents by seizure type, and prescribing decision processes. Guideline-concordant drug selection by seizure type was documented in 61.7 percent of prescriptions. Phenobarbitone remained the most frequently prescribed agent (42.8 percent), despite its non-preferred status in most seizure categories per current guidelines. Valproate use in women of childbearing age without documented teratogenicity counselling occurred in 38.4 percent of applicable cases. Knowledge of current guideline classifications was adequate in only 43.6 percent of prescriber survey respondents. The study identifies specific adherence gaps and recommends CME sessions on contemporary antiepileptic drug therapy, pharmacist-prescriber epilepsy guideline review rounds, and a formulary update aligning available antiepileptics with current guideline recommendations.

Keywords: antiepileptic drugs, prescribing guidelines, epilepsy management, Kano State, pharmacotherapy adherence