Renée A Shellhaas1, Anne T Berg2, Zachary M Grinspan3, Courtney J Wusthoff4, John J Millichap2, Tobias Loddenkemper5, Jason Coryell6, Russell P Saneto7, Catherine J Chu8, Sucheta M Joshi9, Joseph E Sullivan10, Kelly G Knupp11, Eric H Kossoff12, Cynthia Keator13, Elaine C Wirrell14, John R Mytinger15, Ignacio Valencia16, Shavonne Massey17, William D Gaillard18. 1. Department of Pediatrics, University of Michigan, Ann Arbor, Michigan. Electronic address: shellhaa@med.umich.edu. 2. Epilepsy Center, Lurie Children's Hospital; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 3. Weill Cornell Medicine; New York Presbyterian Hospital; Health Information Technology Evaluation Collaborative, New York, New York. 4. Division of Child Neurology, Stanford University, Palo Alto, California. 5. Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 6. Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, Oregon. 7. Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington. 8. Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts. 9. Department of Pediatrics, University of Michigan, Ann Arbor, Michigan. 10. Department of Neurology, University of California San Francisco, San Francisco, California. 11. Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 12. Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland. 13. Cook Children's Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, Texas. 14. Department of Neurology, Mayo Clinic, Rochester, Minnesota. 15. Department of Pediatrics, the Ohio State University; Nationwide Children's Hospital, Columbus, Ohio. 16. Section of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania. 17. Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 18. Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia.
Abstract
OBJECTIVE: There 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, nonsyndromic, early-life epilepsy (onset before age three years). METHODS: Seventeen 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. RESULTS: About half of the 495 enrolled children with new-onset, nonsyndromic epilepsy were less than 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 of 163 (31%) infants less than six months old versus seven of 300 (2.3%) of children six months or older (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. CONCLUSIONS: Without 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.
OBJECTIVE: There 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, nonsyndromic, early-life epilepsy (onset before age three years). METHODS: Seventeen 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. RESULTS: About half of the 495 enrolled children with new-onset, nonsyndromic epilepsy were less than 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 of 163 (31%) infants less than six months old versus seven of 300 (2.3%) of children six months or older (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. CONCLUSIONS: Without 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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Jo M Wilmshurst; William D Gaillard; Kollencheri Puthenveettil Vinayan; Tammy N Tsuchida; Perrine Plouin; Patrick Van Bogaert; Jaime Carrizosa; Maurizio Elia; Dana Craiu; Nebojsa J Jovic; Doug Nordli; Deborah Hirtz; Virginia Wong; Tracy Glauser; Eli M Mizrahi; J Helen Cross Journal: Epilepsia Date: 2015-06-30 Impact factor: 5.864
Authors: Zachary M Grinspan; Renée A Shellhaas; Jason Coryell; Joseph E Sullivan; Elaine C Wirrell; John R Mytinger; William D Gaillard; Eric H Kossoff; Ignacio Valencia; Kelly G Knupp; Courtney Wusthoff; Cynthia Keator; Nicole Ryan; Tobias Loddenkemper; Catherine J Chu; Edward J Novotny; John Millichap; Anne T Berg Journal: JAMA Pediatr Date: 2018-04-01 Impact factor: 16.193