Prescription Patterns of Antiseizure Medication in Adult Patients with Epilepsy in Kazakhstan (2021–2023)

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1) The paper is well-written and sufficiently clear.

2) In some parts of the paper (including the title), the term AntiEpileptic Drug (AED) is used, while in other parts, Anti-Seizure Medication is used. All the paper should be aligned, following the latest guidelines from the International League Against Epilepsy (ILAE), which recommend the use of the terms: Anti-Seizure Medication (ASM) or Anti-Seizure Drug (ASD).

3) It should also be clarified (also in the title) that the data and related conclusions do not concern all epilepsies, but only those in adults, and perhaps only in the middle-aged age group. In the methods section it is specify that the childhood and adolescent age group is excluded but but also the old age it seems to be excluded. The median age reported in the results should be compared to the life expectancy in Kazakhstan to determine whether the results apply to the entire adult population or only to middle-aged patients.

4) In addition to the classification of syndromes based on the IC 10 system (it would have been better to use the Syndromic Classification proposed by the ILAE), it would be very useful also to include the etiologies of symptomatic cases. This provides a more precise idea of the comorbidities present in the patients and thus better correlates the related classes and types of non-ASM therapies taken by the patients themselves.

5) All parts of the paper are a bit redundant and should be streamlined to make it less difficult to read.

Author Response

Dear Reviewer 1,

Thank you very much for your valuable and constructive feedback on our manuscript. We have carefully addressed all comments and revised the text accordingly to improve clarity and consistency. Please find the detailed response document attached.

 

Kind regards,

Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript presents a comprehensive and well-structured analysis of nationwide prescribing patterns of antiepileptic drugs (AEDs) in Kazakhstan between 2021 and 2023. The study is timely, methodologically sound, and provides valuable real-world evidence from a region where large-scale pharmacoepidemiological data are scarce. The paper is well written, the objectives are clear, and the results are appropriately interpreted within the clinical and public health context.

Overall, I find the study of high quality and suitable for publication after minor revision. The following points are suggested to further strengthen the manuscript:

1. Clarify data limitations – Although the authors have briefly discussed the absence of dosage and seizure control information, this section could be slightly expanded to emphasize how such limitations are typical for administrative datasets and do not undermine the study’s validity.
2. Enhance visualization of drug trends – Including a figure or graphical trend summarizing year-to-year changes in the use of key AEDs (e.g., lamotrigine, levetiracetam, valproate) would make the results section more accessible and visually appealing.
3. Add brief contextual remarks – A short paragraph linking the observed prescribing trends to national health policy or medication availability (e.g., formulary inclusion or cost constraints) would enrich the Discussion and provide readers with a clearer system-level perspective.

In summary, this is a well-conducted study that makes a valuable contribution to understanding epilepsy pharmacotherapy in a Central Asian setting. With minor revisions addressing the above points, I would be pleased to recommend this manuscript for publication.

 

Author Response

Dear Reviewer 2,

Thank you very much for your valuable and constructive feedback on our manuscript. We have carefully addressed all comments and revised the text accordingly to improve clarity and consistency.

Please find the detailed response document attached.

 

Kind regards,

Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This is a clear and complete paper on antiepileptic medication prescription in Kazakhstan (2021-2023)

The introduction outlines, with a rich bibliography, the various  aspects  related to this topic: LMICs with high level of untreated patients, monotherapy vs polytherapy, “first generation” AEDs, teratogenicity, frequent comorbidities with possible drug interactions. The population included is of almost 55000 patients. The results are precisely described with tables and figures which summarize the data presented. The discussion points out the many problems connected to antiepileptic prescriptions already presented in the introduction particularly in comorbidities ( which requires  a multidisciplinary approach), health care access, drug availability, the importance of the telemedicine development. “ Sustaining robust seizure control while minimizing unnecessary polypharmacy and addressing broader health needs remains a central objective”

Author Response

Dear Reviewer 3,

We sincerely thank you for the encouraging comments on our manuscript’s importance and presentation. We are pleased that you found the study valuable.

 

Kind regards,

Authors

Reviewer 4 Report

Comments and Suggestions for Authors

This manuscript addressed the prescription pattern of antiepileptic drugs over the period from 2021 to 2023 in Kazakhstan. The good point is that it involves a large number of patients. However, it missed some points that need to be addressed, 

1- The experimental design missed the inclusive and exclusive criteria for selection of patients

2- It isn't clear if the patients selected were male or female or both; at least the gender should be stated and their percentage. 

3- In case of valproic acid, sometimes pregnancy or its hepatotoxicity limits its use

Therefore, I suggest the authors should include causes for the switch from one AED to another

4- Abstract is too long; I guess 250 words are enough to write the abstract

5- Economic status is a point to be considered. It is not clear if patients can receive their prescription through a medical insurance system or Do they have to stick with older and cheaper AED despite their ADR?!

6- I wonder if there are any data regarding patient compliance?

 

 

Author Response

Dear Reviewer 4,

Thank you very much for your valuable and constructive feedback on our manuscript. We have carefully addressed all comments and revised the text accordingly to improve clarity and consistency.

Please find the detailed response document attached.

 

Kind regards,

Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

The authors have addressed all the mentioned comments, which greatly improved the quality of the manuscript.