Abstracts

Over the past 12 years, many new epilepsy treatments have been approved. For most pediatric epilepsy syndromes no trials compare active therapies, further compounding treatment decisions. We sought to address these shortcomings by using the expert consensus method, and conducted the first survey ever in pediatrics. Forty pediatric epilepsy experts were selected to receive the pediatric epilepsy consensus survey. Selection was based on recent publications and geographic distribution. The experts answered 33 questions, with 418 possible answers. Topics addressed were 1.overall treatment strategies (sequencing both drug and nonpharmacologic treatments) for common childhood epilepsies, and 2.specific treatment choices for common childhood epilepsies. Valproate, topiramate and zonisamide were considered first line therapy for the treatment of symptomatic myoclonic and generalized tonic-clonic seizures regardless of age.Vigabatrin was the drug of choice for infantile spasms secondary to tuberous sclerosis complex (TSC), while ACTH was the drug of choice in symptomatic infantile spasms not due to TSC. Valproate was the drug of choice in treating astatic seizures in a child with Lennox-Gastaut syndrome (LGS), however, if this was not successful, then topiramate was considered the drug of choice. Ethosuximide was the first choice for treatment of childhood absence epilepsy (CAE), whereas valproate and lamotrigine were considered both to be the treatments of choice for juvenile absence. If ethosuximide was not successful in CAE, then valproate and lamotrigine were considered first line choices. Both carbamazepine and oxcarbazepine were considered first choices in treating benign rolandic epilepsy of childhood.Oxcarbazepine and carbamazepine were also considered the first choices to treat cryptogenic complex partial seizures of childhood.Valproate and lamotrigine were considered the first choices to treat juvenile myoclonic epilepsy in an adolescent male, while lamotrigine was the first choice in an adolescent female. Rectal diazepam was the first choice for the acute treatment of a febrile seizure, while no therapy was considered the first choice for prophylaxis.The treatment sequence for either complex partial or generalized tonic-clonic status epilepticus (S.E.) in a child was intravenous(IV) lorazepam, followed by IV fosphenytoin, if needed.The treatment sequence for absence S.E. was IV lorazepam, followed by IV valproate, if needed. Phenobarbital was the first choice in treating neonatal seizures. The results of the first ever pediatric epilepsy expert survey can be used to develop overall treatment strategies and choices of specific medications for seizure emergencies in childhood, and specific childhood epilepsy syndromes.These can be used to help guide future comparative multi-centered treatment trials in pediatric epilepsy and in specific epilepsy syndromes unique to pediatrics. (Supported by Abbott, Cyberonics, Novartis, Ortho-McNeil,GSK, UCB, Shire.)