Abstracts

Rationale: Data from clinical trials in pediatric epilepsy is very limited and insufficient for the preparation of evidence-based guidelines for initial monotherapy. There is lack of high class evidence especially in case of generalized seizures/epilepsies in children. In case of juvenile myoclonic epilepsy (JME), representing 5-10% of all epilepsies, use of valproate (VPA) as initial treatment remains controversial after many years of use. The aim of this study was to evaluate the expert opinion from pediatric epileptologists in their treatment choices for absence epilepsy and juvenile myoclonic epilepsy. Methods: A questionnaire survey has been performed among epileptologists experienced in treatment of children. They were asked to evaluate usefulness of therapeutic options in described clinical situation (initial treatment choice for childhood (CAE) and juvenile (JAE) absence epilepsies and JME). The experts rated utility of treatment options using a 9-point scale. The mean, standard deviation, and 95% confidence interval as well chi-square testing were performed to categorize treatment options as treatment of choice and from 1st to 3rd line treatments. Results: The survey was sent to 70 experts, 51 (73%) of them completed the questionnaire. For untreated CAE treatments of choice were VPA and ESM. If ESM treatment was unsuccessful, 100% of responders choose VPA as a first line therapy followed by LTG. In treatment of JAE treatment of choice was VPA. LTG was the treatment of choice in case for unsuccessful treatment with VPA. In JME the decision about initial treatment depended on gender of patient. Treatment of choice in male was VPA and LEV, LTG and TPM as second-line agents. In case of female treatment of choice was LTG followed by first-line VPA and LEV. Conclusions: Recommendations for CAE reflect recent ILAE evidence update for initial treatment pointing highest class evidence for use of VPA and ESM in childhood absence seizures. Lack of similar recommendation for ESM in JAE came from different disease course and no benefit of ESM in generalized tonic-clonic seizures which occur more often in this syndrome. Treatment selection for JME reflected experts concern about VPA use in young woman due to teratogenic effect and potential influence of cognitive function of offspring. UCB Pharma, Warsaw, Poland supported preparation and distribution of questionnaires, data management and analysis, preparation of figures and preparation of this poster.