Initial Treatment for Non-Syndromic Early-Life Epilepsy: an Unexpected Consensus

Publication date: Available online 27 June 2017
Source:Pediatric Neurology
Author(s): Renée A Shellhaas, Anne T Berg, Zachary M Grinspan, Courtney J Wusthoff, John J Millichap, Tobias Loddenkemper, Jason Coryell, Russell P. Saneto, Catherine J Chu, Sucheta M Joshi, Joseph E Sullivan, Kelly G Knupp, Eric H Kossoff, Cynthia Keator, Elaine C Wirrell, John R Mytinger, Ignacio Valencia, Shavonne Massey, William D. Gaillard
ObjectiveThere are no evidence-based guidelines on the preferred approach to treating early-life epilepsy. We examined initial therapy selection in a contemporary US cohort of children with newly diagnosed, non-syndromic, early-life epilepsy (onset <3 years).MethodsSeventeen pediatric epilepsy centers participated in a prospective cohort study of children with newly diagnosed epilepsy with onset under 36 months of age. Details regarding demographics, seizure types, and initial medication selections were obtained from medical records.ResultsAbout half of the 495 enrolled children with new-onset, non-syndromic epilepsy were <12 months old at the time of diagnosis (N=263, 53%) and about half (N=260, 52%) had epilepsy with focal features. Of 464 who were treated with monotherapy, 95% received one of five drugs: levetiracetam (N=291, 63%), oxcarbazepine (N=67, 14%), phenobarbital (N=57, 12%), topiramate (N=16, 3.4%), and zonisamide (N=13, 2.8%). Phenobarbital was prescribed first for 50/163 (31%) infants <6 months old versus 7/300 (2.3%) of those >6 months old (p<0.0001). Although the first treatment varied across study centers (p<0.0001), levetiracetam was the most commonly prescribed medication regardless of epilepsy presentation (focal, generalized, mixed/uncertain). Between the first and second treatment choices, 367 (74%) of children received levetiracetam within the first year after diagnosis.ConclusionsWithout any specific effort, the pediatric epilepsy community has developed an unexpectedly consistent approach to initial treatment selection for early-life epilepsy. This suggests that a standard practice is emerging, and could be utilized as a widely acceptable basis of comparison in future drug studies.



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