Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus

Renée A. Shellhaas, Anne T. Berg, Zachary M. Grinspan, Courtney J. Wusthoff, John J. Millichap, Tobias Loddenkemper, Jason Coryell, Russell P. Saneto, Catherine J. Chu, Sucheta M. Joshi, Joseph E. Sullivan, Kelly G. Knupp, Eric H. Kossoff, Cynthia Keator, Elaine C Wirrell, John R. Mytinger, Ignacio Valencia, Shavonne Massey, William D. Gaillard

Research output: Contribution to journalArticle

6 Citations (Scopus)

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 <6 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.

Original languageEnglish (US)
JournalPediatric Neurology
DOIs
StateAccepted/In press - 2017

Fingerprint

etiracetam
Epilepsy
zonisamide
Partial Epilepsy
Phenobarbital
Therapeutics
Pediatrics
Age of Onset
Pharmaceutical Preparations
Medical Records
Seizures
Cohort Studies
Demography
Prospective Studies
Guidelines

Keywords

  • Antiepileptic drugs
  • Epilepsy
  • Focal seizures
  • Generalized seizures
  • Levetiracetam
  • Oxcarbazepine
  • Phenobarbital

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Shellhaas, R. A., Berg, A. T., Grinspan, Z. M., Wusthoff, C. J., Millichap, J. J., Loddenkemper, T., ... Gaillard, W. D. (Accepted/In press). Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus. Pediatric Neurology. https://doi.org/10.1016/j.pediatrneurol.2017.06.011

Initial Treatment for Nonsyndromic Early-Life Epilepsy : An Unexpected Consensus. / Shellhaas, Renée A.; Berg, Anne T.; Grinspan, Zachary M.; Wusthoff, Courtney J.; Millichap, John J.; Loddenkemper, Tobias; Coryell, Jason; Saneto, Russell P.; Chu, Catherine J.; Joshi, Sucheta M.; Sullivan, Joseph E.; Knupp, Kelly G.; Kossoff, Eric H.; Keator, Cynthia; Wirrell, Elaine C; Mytinger, John R.; Valencia, Ignacio; Massey, Shavonne; Gaillard, William D.

In: Pediatric Neurology, 2017.

Research output: Contribution to journalArticle

Shellhaas, RA, Berg, AT, Grinspan, ZM, Wusthoff, CJ, Millichap, JJ, Loddenkemper, T, Coryell, J, Saneto, RP, Chu, CJ, Joshi, SM, Sullivan, JE, Knupp, KG, Kossoff, EH, Keator, C, Wirrell, EC, Mytinger, JR, Valencia, I, Massey, S & Gaillard, WD 2017, 'Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus', Pediatric Neurology. https://doi.org/10.1016/j.pediatrneurol.2017.06.011
Shellhaas, Renée A. ; Berg, Anne T. ; Grinspan, Zachary M. ; Wusthoff, Courtney J. ; Millichap, John J. ; Loddenkemper, Tobias ; Coryell, Jason ; Saneto, Russell P. ; Chu, Catherine J. ; Joshi, Sucheta M. ; Sullivan, Joseph E. ; Knupp, Kelly G. ; Kossoff, Eric H. ; Keator, Cynthia ; Wirrell, Elaine C ; Mytinger, John R. ; Valencia, Ignacio ; Massey, Shavonne ; Gaillard, William D. / Initial Treatment for Nonsyndromic Early-Life Epilepsy : An Unexpected Consensus. In: Pediatric Neurology. 2017.
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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 <6 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.",
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TY - JOUR

T1 - Initial Treatment for Nonsyndromic Early-Life Epilepsy

T2 - An Unexpected Consensus

AU - Shellhaas, Renée A.

AU - Berg, Anne T.

AU - Grinspan, Zachary M.

AU - Wusthoff, Courtney J.

AU - Millichap, John J.

AU - Loddenkemper, Tobias

AU - Coryell, Jason

AU - Saneto, Russell P.

AU - Chu, Catherine J.

AU - Joshi, Sucheta M.

AU - Sullivan, Joseph E.

AU - Knupp, Kelly G.

AU - Kossoff, Eric H.

AU - Keator, Cynthia

AU - Wirrell, Elaine C

AU - Mytinger, John R.

AU - Valencia, Ignacio

AU - Massey, Shavonne

AU - Gaillard, William D.

PY - 2017

Y1 - 2017

N2 - 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 <6 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.

AB - 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 <6 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.

KW - Antiepileptic drugs

KW - Epilepsy

KW - Focal seizures

KW - Generalized seizures

KW - Levetiracetam

KW - Oxcarbazepine

KW - Phenobarbital

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