Abstracts

Rationale: Obesity is a nationwide epidemic affecting all ages. No pediatric studies have identified how frequently obesity occurs in children and adolescents with new onset epilepsy prior to treatment administration. The recognition of obesity prior to initiation of AED therapy can have significant impact on drug selection due to the positive and negative weight effects of some commonly used AEDs. This study aimed to determine the frequency of obesity in a cohort of children and adolescents with newly diagnosed untreated epilepsy.Methods: A consecutive cohort of 251 patients (2-18 years of age) with newly diagnosed untreated epilepsy was identified from the New Onset Seizure clinic at Cincinnati Children’s Hospital. Weight, height, and concomitant medications were recorded at the time of each patient’s first visit. Body Mass Index Z-scores and percentiles adjusted for age were used as a measure for obesity. Anthropometric status was determined using a SAS program based on standard CDC growth charts (2000). Epilepsy patients’ body mass index z-scores (BMIZ) were compared to CDC data using a 1-sample t-test. A secondary analysis examined the prevalence estimates of overweight and obesity in the general pediatric population from the NHANES III data set (a multistage probability sample of U.S. civilians) and compared this sample to the cohort of epilepsy patients. The SURVEYREG procedure in SAS was used to account for the complex sampling design of NHANES. To determine the relationship between BMI Z-scores and potential covariates, a series of analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted. Covariates not reaching a P-value of 0.50 were excluded from a subsequent multivariable analysis. Potential covariates included in the ANCOVA were age, etiology (cryptogenic, idiopathic, and symptomatic), seizure type (general, partial, unclear), concomitant medications (stimulants, non-stimulants, none), and insurance status (Private, Medicaid).Results: There was a statistically significant difference in means BMI Z-scores between the epilepsy and CDC cohorts (P<0.0001). Thirty nine % of children had BMI percentile for age>85th% and 20% were>95th%. The mean Z-score of the NHANES III cohort was not statistically different than the mean Z-score of the epilepsy cohort (P=0.45). In unadjusted analyses, concomitant medications and etiology were significantly associated with BMI Z-score (all P<0.05). Adjusted, ANCOVA revealed three significant predictors which included age, etiology, and concomitant medications (all P<0.05).Conclusions: Obesity is a common pre-existing comorbidity in children with newly diagnosed untreated epilepsy. Patients with idiopathic/cryptogenic epilepsy or those not on stimulant medications are more likely to have higher BMI Z-scores than those patients with symptomatic epilepsy, or patients taking stimulant medication. Clinicians should calculate BMI scores and percentiles adjusting for age for every epilepsy patient prior to starting AED therapy, and incorporate it into their clinical decisions when selecting medication. (Source of funding: NIH NS044956)