Antiseizure medication treatment outcomes in new-onset pediatric epilepsy
Shinji Itamura1, Kasumi Sasaki1, Yuji Fujii1
1Department of Pediatrics, Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan.
Insights
Antiseizure medication (ASM) treatment for new-onset pediatric epilepsy shows diminishing returns, with efficacy dropping significantly after the third regimen. Alternative treatments should be considered for children with refractory epilepsy.
Area of Science:
- Pediatric Neurology
- Epilepsy Treatment
- Pharmacology
Background:
- Antiseizure medications (ASMs) are the cornerstone of epilepsy management.
- Previous studies in adults indicated reduced efficacy of third and subsequent ASMs.
- This study investigates ASM outcomes in new-onset pediatric epilepsy.
Approach:
- Retrospective analysis of 281 pediatric epilepsy patients.
- Data collected from July 2015 to August 2022.
- Seizure freedom defined as 12+ months without seizures.
Key Points:
- 65.1% seizure freedom with the first ASM regimen.
- 51.1% seizure freedom with the second ASM regimen.
- Only 37.5% seizure freedom with the third or subsequent ASM regimens.
Conclusions:
- ASM efficacy declines notably after the third regimen in pediatric epilepsy.
- Similar to adults, third-line ASMs show poor outcomes in children.
- Exploring non-ASM treatment options is crucial for refractory pediatric epilepsy.
Background:
Antiseizure medications (ASMs) are the primary treatment for epilepsy; however, some prospective cohort studies in adults suggested that the efficacy of the third and subsequent ASM treatments are poor. Thus, we aimed to assess the outcomes of ASM treatment in new-onset pediatric epilepsy.
Methods:
We retrospectively studied 281 pediatric patients diagnosed with epilepsy, in which the first ASM was prescribed between July, 2015, and June, 2020, at Hiroshima City Funairi Citizens Hospital. We reviewed their clinical profiles and seizure outcomes at the end of the study in August, 2022. Seizure freedom was defined as having no seizures for the previous 12 months or longer.
Results:
Age at the onset of epilepsy ranged from 22 days to 186 months (mean: 84 months). The most frequent classifications of the types and syndromes of epilepsy were focal epilepsy (n = 151, 53.7%), followed by generalized epilepsy (n = 30, 10.7%), and self-limited epilepsy with centrotemporal spikes (n = 20, 7.1%). During the first ASM regimen, 183 out of the 281 (65.1%) patients became seizure free. During the second ASM regimen, 47 out of the 92 (51.1%) patients became seizure free. Only 15 out of the 40 (37.5%) patients who tried the third and subsequent ASM regimen became seizure free, while none became seizure free after the sixth and subsequent ASM regimen.
Conclusions:
The efficacy of ASM treatment after the third and subsequent regimen was poor in children, as well as in adults. It is important to reconsider whether there are indications for treatments other than ASM.
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