Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: A survey to assess the usage pattern of Levetiracetam in the management of epilepsy in India

Epilepsy is characterized by recurrent seizures caused by abnormal neuronal discharges in the brain.^1,2,3. Epilepsy is the third leading contributor to the global burden of disease for neurological disorders. ^4,5 At the global level, it is estimated that approximately 70 million people suffer from epilepsy and prevalence of epilepsy is estimated to be 5 to 9 per 1000 population.⁶ It is estimated that there are more than 10 million persons with epilepsy (PWE) in India⁷. Its prevalence is about 1% in our population. The prevalence is higher in the rural (1.9%) compared to urban population (0.6%).^8,9

A focal onset seizure refers to abnormal neural activity in only one brain area within one brain hemisphere with a fixed focal or localized onset. Focal onset seizures are divided into 2 subtypes: motor onset and nonmotor onset. Both focal motor and focal nonmotor onset seizures can be further classified based on level of awareness: aware, impaired, and unknown awareness. The motor manifestations of focal motor onset seizures can be characterized as automatism, atonic, clonic, epileptic spasms, hyperkinetic, myoclonic, or tonic movements. The behavioral manifestations of focal nonmotor onset seizures can be described by autonomic, behavioral arrest, cognitive, emotional, or sensory symptoms.¹⁰

Epilepsy can persist for years and often for the patient's lifetime. ASDs (Anti-seizure drug) are the primary therapy for epilepsy and are symptomatic treatments that control seizures.¹¹ The choice of ASDs varies with different seizure types and epileptic syndromes. About 30 ASDs are currently used, of which most were approved over the last 30 years.¹²

Levetiracetam and Partial Seizure Subtypes, pooled Data from Three Randomized, Placebo- controlled Trials showed the median percentage reduction from baseline with LEV was 42.7% for simple partial seizures, 36.1% for complex partial seizures, and 68.5% for secondarily generalized seizures (p < 0.05 for all seizure types vs. placebo). The 50% responder rate for all partial seizures was 34.9% for LEV versus 12.6% for placebo (p < 0.001). The 100% responder rates were 5.9 and 0.7%, respectively (p<0.001). The percentage of patients in whom secondarily generalized seizures could be prevented over and above the reduction of all partial seizures was significantly greater in the LEV group (59.5%) than in the placebo group (44.9%). The odds ratio comparing prevention of secondarily generalized tonic–clonic seizures with LEV therapy with placebo was 1.83.¹³

As you will be spending some extra time to give your feedback on the questionnaire based on your clinical experience, we offer to pay you by cheque a professional fee of Rs {{$contractAmount}}, on receiving the completed Survey Questionnaire Form from you.

We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.