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Treatment of infants with seizures varies worldwide
Treatment methods for infant patients with seizures vary slightly across all regions of the world, suggesting more in-depth research is needed to establish useful treatment guidelines.
“Data relating to the optimal care for infants with seizures are lacking,” Jo M. Wilmshurst, MD, MBBS, head of pediatric neurology and neurophysiology at Red Cross War Memorial Children’s Hospital, South Africa, and colleagues wrote. “This lack of data affects the management for most seizure types in childhood, but is especially so for the infantile period.”
Jo Wilmshurst
Researchers developed a survey with the International League Against Epilepsy to inventory and analyze treatment methods currently practiced worldwide. The online survey was deployed to numerous pediatric neurologist and epileptologist societies and associations between November 2012 and March 2013. The researchers collected 733 responses from 96 countries.
Study results suggested that 2% of physicians implement the use of antiepileptic drugs in infants after just one seizure. However, 71% of physicians recommended both rapid increments and gradual introduction of antiepileptic drugs for infants experiencing chronic seizure types.
Treatment of specific seizure conditions varied. Focal seizures were most often treated with carbamazepine (35%) or oxcarbazepine (21%). Although, in North America levetiracetam is more likely to be used than oxcarbazepine (OR = 5.281; 95% CI, 3.24–8.607).
Generalized seizures were most often treated with valproate, except in North America (58%) and Oceania (20%), where the most commonly reported drug was levetiracetam. In resource-limited regions such as Africa, phenobarbital was used most commonly to treat focal and generalized seizures.
Myoclonic seizures were most commonly treated with valproate (55%), although the reported usage of levetiracetam was significantly higher in North America (OR = 5.631; 95% CI, 3.602–8.804).
Valproate was reported to be used most commonly for first-line Dravet syndrome worldwide, aside from in North America, where clobazam was reported as the most common treatment (OR = 6.28; 95% CI, 3.425–11.516).
The researchers said the wide use of levetiracetam in North America could be due to successful marketing strategies that are based on reliable clinical data. Further, the common use of valproate in resource-limited regions may be a cause for safety concerns, due to the lack of proper screening measures. The researchers suggested that these findings be used as a basis for more-focused clinical studies.
“There is a great need for randomized controlled trials that are clinically relevant to day-to-day practice, and for which the outcomes acquired could be used to effectively direct and improve practice,” Wilmshurst and colleagues wrote. “This study provides the data necessary to select medications for randomized controlled trials and questions that need to be addressed to improve care of infants with epilepsy.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
