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First-Drug Efficacy and Drug-Resistant Epilepsy Rates in Children With New-Onset Epilepsies: A Multicenter Large
Pinar Gencpinar1, Pinar Arican2, Nihal Olgac Dündar1
1Department of Pediatric Neurology, İzmir Katip Çelebi Üniversity, Izmir, Turkey.
Insights
In newly diagnosed children with epilepsy, the first antiseizure medication achieved seizure control in 67% of cases, but 33% experienced treatment failure. Drug-resistant epilepsy affected 15% of the cohort, with structural causes showing lower efficacy rates.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Newly diagnosed epilepsy in children requires effective initial treatment strategies.
- Understanding first-drug efficacy is crucial for optimizing pediatric epilepsy management.
- Drug resistance in pediatric epilepsy poses significant long-term challenges.
Purpose of the Study:
- To evaluate the efficacy of the first antiseizure medication (ASM) in children with newly diagnosed epilepsy.
- To determine the first-drug failure rate and the overall drug-resistant epilepsy rate in this pediatric cohort.
- To explore the influence of seizure onset type and etiology on treatment outcomes.
Main Methods:
- Retrospective analysis of 1003 children (aged 3-10 years) with newly diagnosed epilepsy.
- Evaluation of first-drug efficacy, first-drug failure, and drug resistance rates.
- Comparison of outcomes based on seizure onset (focal vs. generalized) and etiology (structural, genetic, unknown).
Main Results:
- The first-drug failure rate was 33%, with 31% experiencing no seizure control.
- First-drug efficacy was comparable for focal-onset (67%) and generalized-onset (66%) seizures.
- Drug-resistant epilepsy was observed in 15% of patients; structural etiology showed lower efficacy (53%) and higher resistance (30%).
Conclusions:
- A substantial proportion (33%) of children with newly diagnosed epilepsy experience first-drug failure.
- Drug-resistant epilepsy affects 15% of this pediatric population.
- Etiology, particularly structural causes, significantly impacts first-drug efficacy and the risk of drug resistance.
Abstract:
Objective: This study aimed to assess the first-drug efficacy rate in newly diagnosed children with epilepsies treated with antiseizure medications. Methods: This retrospective study was conducted on 1003 children (age range: 3-10 years, and the mean duration of follow-up: 22 ± 13 months) with newly diagnosed epilepsy. The following parameters were evaluated: first-drug efficacy rate, first-drug-failure rate, and drug resistance rate in the cohort. Results: The first-drug-failure rate was defined in 335/1003 (33%) of the patients, no seizure control in 315 (31%), and drug withdrawal in 20 (2%). There was no significant difference between the group with focal-onset seizures and the group with generalized onset seizures. The first-drug efficacy rate was 67% in children with focal-onset seizures and 66% in children with generalized-onset seizures. Adjunctive antiseizure medication therapy was initiated in 335 patients-dual therapy with 180 patients (18%) and polytherapy with 155 (15%). Drug-resistant epilepsy was defined as 15% in the follow-up period. Etiology-specific diagnoses of the cohort were structural (n = 165, 17%), genetic (n = 25, 3%), metabolic (n = 15%), immune-infectious (n = 17 (2%), and unknown (n = 781, 77%). With a comparison of the 2 most common etiology subgroups (structural versus unknown), a first-drug efficacy rate of 53% and a higher prevalence of drug-resistant epilepsy at 30% were observed in children with structural etiology. First-drug efficacy was statistically lower in children without well-defined epilepsy syndromes (65%) compared with the rate of those with well-defined epilepsy syndrome (79%). Conclusion: This study revealed a first-drug failure rate (33%) in the presented cohort with a drug-resistance epilepsy rate (15%).
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