Abstracts

Rationale: Childhood epilepsy with centrotemporal spikes (CECTS), which is currently known as Self-limited epilepsy with centro-temporal spikes (SeLECTS), is the most common type of self-limited focal epilepsy of childhood. As seizures are mostly infrequent, many clinicians do not start anti-seizure medication (ASM). However, when seizures tend to be more frequent or prolonged, ASMs are warranted and there is a wide variation in choice of ASM and there is no consensus on the first-choice medication to treat SeLECTS.  Therefore, we conducted this study to evaluate the most commonly used ASM in the treatment of SeLECTS and to compare their efficacy and tolerance.

Methods: We performed a retrospective chart review study of all children seen at University of Iowa Pediatric Neurology Clinic between January 2013 and January 2020 with a diagnosis of Childhood epilepsy with centrotemporal spikes (CECTS) and benign Rolandic epilepsy (BRE). We divided the children into two categories based on whether they were started on ASMs or not. We collected multiple clinical variables and analyzed the efficacy and side effect profile of commonly used ASMs in our institution.

Results: There were a total of 71 children identified with a diagnosis of BRE or CECTS in the study. Forty-seven of the patients (66%) were males and 24 (34%) were females.  Of the 71 patients, forty-eight patients (68%) were started on ASMs, and 23 patients (32%) were not. Median age at onset of seizures was 7.8 years [IQR: 4.9-8.9]. Levetiracetam (LEV) was the most common ASM prescribed in 24 patients (50%), followed by oxcarbazepine (OXC) in 10 (21%), carbamazepine (CBZ) in 9 (19%), valproic acid in 3 (6%) and lamotrigine in 2 (4%). Nineteen of the 48 patients (40%) switched to different ASM(s)- 10 due to poor tolerance, 8 due to lack of efficacy and one due to both. Median duration of treatment for the patients started on ASM was 48 months [IQR 30.7 -67.2]. Patients started on ASMs were noted to have a relatively longer duration of the initial presenting seizure, in comparison to the patients not started on treatment. (p- value of 0.022). There was no change in the trend of provider's decision to start or defer treatment with ASMs over the study period, but we did note that levetiracetam was the ASM most frequently chosen recently. Pairwise comparisons between the ASM groups, with Tukey adjustment applied to the p-values, showed a 62% (95% CI: 12%, 88%, p=0.025) lower seizure frequency rate in those treated with LEV compared to CBZ and 74% (95% CI: -94%, +16%; p=0.086) lower seizure frequency in those treated with LEV compared to OXC. The seizure rate after start of LEV was 1 seizure every 16.2 (95% CI: 7.5, 35.1) months compared to 1 seizure every 5.2 (95% CI: 3.7, 7.3) months for CBZ and 1 seizure every 4.3 (95% CI: 1.7, 11.2) months for OXC.

Conclusions: Levetiracetam was the most commonly used ASM in the treatment of SeLECTS. The patients with long duration of seizures on presentation ( >5minutes) were more likely to be started on treatment. Following treatment with ASM, levetiracetam had the least mean seizure frequency per month followed by carbamazepine and oxcarbazepine respectively.

Funding: We received no funding for this study