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Treatment of newly diagnosed pediatric epilepsy: a community-based study
A T Berg1, S R Levy, F M Testa
1Department of Biological Sciences, Northern Illinois University, DeKalb 60115, USA. atberg@niu.edu
Insights
Approximately 20% of children with epilepsy in Connecticut were untreated at diagnosis, with 10% remaining untreated after one year. Carbamazepine and sodium valproate were the most common first-line antiepileptic drugs (AEDs) prescribed.
Area of Science:
- Neurology
- Pediatric Epilepsy Treatment
Background:
- Epilepsy is a common neurological disorder in children.
- Treatment patterns and drug utilization for newly diagnosed pediatric epilepsy are not well-defined.
Purpose of the Study:
- To determine the patterns and frequency of treatment for newly diagnosed pediatric epilepsy.
- To identify the specific antiepileptic drugs (AEDs) used in this population.
Main Methods:
- Prospective, community-based study in Connecticut (1993-1997).
- Recruited children aged 1 month to 15 years with newly diagnosed epilepsy (2+ unprovoked seizures).
- Tracked initiation of treatment at diagnosis and within 1 year.
Main Results:
- 482 of 613 children (78.6%) received treatment at diagnosis; 90% were treated by 1 year.
- Carbamazepine (38.8%) and sodium valproate (18.4%) were the most common first AEDs.
- Treatment rates varied by epilepsy type, with idiopathic generalized epilepsy having the highest treatment rates (90-100%).
Conclusions:
- A significant proportion of children with epilepsy remain untreated at diagnosis and after one year.
- Treatment patterns align with current guidelines, with carbamazepine and valproate as preferred first-line AEDs.
- Further research on recently approved AEDs is needed.
Objective:
To determine the patterns and frequency of treatment and use of specific drugs for newly diagnosed pediatric epilepsy.
Design And Setting:
Prospective, community-based study. Children were recruited from physicians in Connecticut from 1993 to 1997.
Patients:
Children aged 1 month through 15 years at the time of their first seizure, who had 2 or more unprovoked seizures, and who were newly diangosed during the recruitment period were eligible.
Main Outcome Measure:
Initiation of treatment at diagnosis and within 1 year after diagnosis of epilepsy.
Results:
Of 613 children, 482 (78.6%) were treated at the time of initial diagnosis. By 6 months another 10.3% were treated, and by 12 months 90% of the cohort had been treated. The most commonly prescribed antiepileptic drug (AED) was carbamazepine (38.8%) followed by sodium valproate (18.4%). Only 1 child received an investigational drug and none received any of the most recently approved drugs as a first AED. Children with idiopathic and secondarily generalized forms of epilepsy were most likely to be treated (90%-100%), whereas children with idiopathic localization-related epilepsy were least likely to be treated (50.8%). Approximately 80% of those with other forms of epilepsy were treated at the time of diagnosis. Use of specific medications reflected current guidelines and recommendations for treatment of specific seizure types and syndromes.
Conclusions:
In Connecticut, approximately 20% of children with epilepsy are not treated at the time of initial diagnosis, and around 10% continue to be untreated after 1 year. This most likely reflects the increased understanding of the nature of pediatric epilepsy and concerns regarding the adverse effects of AEDs. The most commonly used first drugs are carbamazepine and valproate. Follow-up of this cohort may help provide information to guide the use of recently approved AEDs.