Fiona M Baumer1, Nancy A McNamara2, Anthony L Fine3, Elia Pestana-Knight4, Renée A Shellhaas2, Zihuai He5, Daniel H Arndt6, William D Gaillard7, Sarah A Kelley8, Margot Nagan9, Adam P Ostendorf10, Nilika S Singhal11, Laura Speltz12, Kevin E Chapman9. 1. Department of Neurology, Stanford University School of Medicine, Palo Alto, CA. Electronic address: fbaumer@stanford.edu. 2. Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI. 3. Department of Neurology, Divisions of Epilepsy & Child Neurology, Mayo Clinic, Rochester, MN. 4. Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH. 5. Department of Neurology, Stanford University School of Medicine, Palo Alto, CA. 6. Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, MI. 7. Center for Neuroscience, Children's National Hospital, George Washington University, Washington, DC. 8. Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD. 9. Department of Pediatrics & Neurology, University of Colorado, Aurora, CO. 10. Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH. 11. UCSF Weill Institute for Neurosciences, UCSF School of Medicine, San Francisco, CA. 12. Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN.
Abstract
OBJECTIVES: To determine how continuous spike and wave during slow wave sleep (CSWS) is currently managed and to compare the effectiveness of current treatment strategies using a database from 11 pediatric epilepsy centers in the US. STUDY DESIGN: This retrospective study gathered information on baseline clinical characteristics, CSWS etiology, and treatment(s) in consecutive patients seen between 2014 and 2016 at 11 epilepsy referral centers. Treatments were categorized as benzodiazepines, steroids, other antiseizure medications (ASMs), or other therapies. Two measures of treatment response (clinical improvement as noted by the treating physician; and electroencephalography improvement) were compared across therapies, controlling for baseline variables. RESULTS: Eighty-one children underwent 153 treatment trials during the study period (68 trials of benzodiazepines, 25 of steroids, 45 of ASMs, 14 of other therapies). Children most frequently received benzodiazepines (62%) or ASMs (27%) as first line therapy. Treatment choice did not differ based on baseline clinical variables, nor did these variables correlate with outcome. After adjusting for baseline variables, children had a greater odds of clinical improvement with benzodiazepines (OR 3.32, 95%CI 1.57-7.04, P = .002) or steroids (OR 4.04, 95%CI 1.41-11.59, P = .01) than with ASMs and a greater odds of electroencephalography improvement after steroids (OR 3.36, 95% CI 1.09-10.33, P = .03) than after ASMs. CONCLUSIONS: Benzodiazepines and ASMs are the most frequent initial therapy prescribed for CSWS in the US. Our data suggests that ASMs are inferior to benzodiazepines and steroids and support earlier use of these therapies. Multicenter prospective studies that rigorously assess treatment protocols and outcomes are needed.
OBJECTIVES: To determine how continuous spike and wave during slow wave sleep (CSWS) is currently managed and to compare the effectiveness of current treatment strategies using a database from 11 pediatric epilepsy centers in the US. STUDY DESIGN: This retrospective study gathered information on baseline clinical characteristics, CSWS etiology, and treatment(s) in consecutive patients seen between 2014 and 2016 at 11 epilepsy referral centers. Treatments were categorized as benzodiazepines, steroids, other antiseizure medications (ASMs), or other therapies. Two measures of treatment response (clinical improvement as noted by the treating physician; and electroencephalography improvement) were compared across therapies, controlling for baseline variables. RESULTS: Eighty-one children underwent 153 treatment trials during the study period (68 trials of benzodiazepines, 25 of steroids, 45 of ASMs, 14 of other therapies). Children most frequently received benzodiazepines (62%) or ASMs (27%) as first line therapy. Treatment choice did not differ based on baseline clinical variables, nor did these variables correlate with outcome. After adjusting for baseline variables, children had a greater odds of clinical improvement with benzodiazepines (OR 3.32, 95%CI 1.57-7.04, P = .002) or steroids (OR 4.04, 95%CI 1.41-11.59, P = .01) than with ASMs and a greater odds of electroencephalography improvement after steroids (OR 3.36, 95% CI 1.09-10.33, P = .03) than after ASMs. CONCLUSIONS: Benzodiazepines and ASMs are the most frequent initial therapy prescribed for CSWS in the US. Our data suggests that ASMs are inferior to benzodiazepines and steroids and support earlier use of these therapies. Multicenter prospective studies that rigorously assess treatment protocols and outcomes are needed.
Authors: Roberto Horacio Caraballo; Natalia Cejas; Noelia Chamorro; María C Kaltenmeier; Sebastian Fortini; Ana María Soprano Journal: Seizure Date: 2013-10-08 Impact factor: 3.184