Valproate in children with newly diagnosed idiopathic generalized epilepsy

Holland, Katherine D.; Monahan, Sally; Morita, Diego; Vartzelis, George; Glauser, Tracy A.

doi:10.1111/j.1600-0404.2009.01308.x

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…Twenty-six percent of the cohort was in the high seizure probability group, which is consistent with previously reported rates of seizure intractability. [1][2][3] In contrast, three-quarters of the population exhibited a low probability of seizure recurrence over 2 years. This latter group's initial higher probability of seizures soon after diagnosis was likely attributable to the time required to titrate and optimize AED therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the introduction of multiple new efficacious antiepileptic drugs (AEDs), 20% to 35% of children with newly diagnosed epilepsy continue to have seizures. [1][2][3] Several biologically based factors have been examined to understand this disease course, including underlying brain disorders and structural abnormalities, seizure type/etiology, and genetics. 4,5 However, these biological factors, which are nonmodifiable, do not fully explain the variability in seizure outcomes.…”

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Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Modi

Rausch

et al. 2014

Neurology

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Objective: The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes.Methods: This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes.Results: Participants (n 5 109) were 7.3 6 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n 5 10), variable nonadherence (n 5 16), moderate nonadherence (n 5 40), and high adherence (n 5 43). Two seizure probability trajectory groups were identified: high seizure (n 5 28) and low seizure probability (n 5 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b 5 22.372; odds ratio [OR] 5 0.093; 95% confidence interval [CI] OR 5 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b 5 1.649; OR 5 5.203; 95% CI OR 5 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial maxrescaled R 2 5 0.13). Despite the introduction of multiple new efficacious antiepileptic drugs (AEDs), 20% to 35% of children with newly diagnosed epilepsy continue to have seizures. 1-3 Several biologically based factors have been examined to understand this disease course, including underlying brain disorders and structural abnormalities, seizure type/etiology, and genetics. Conclusions:4,5 However, these biological factors, which are nonmodifiable, do not fully explain the variability in seizure outcomes. In contrast, behavioral factors, such as AED nonadherence, are modifiable and may affect long-term seizure outcome. While discrete trajectories of AED nonadherence in children with newly diagnosed epilepsy have been identified, 6 similar trajectories of long-term seizure outcomes have not been examined. Our prior work also indicates that children who are nonadherent to their AEDs within the first 6 months of therapy are 3.24 times more likely to have seizures 4 years after diagnosis. 7 In adults, AED nonadherence increases short-term risk of seizures. 8,9 However, what remains unknown is the relationship between long-term nonadherence and seizure outcome in both adults and children. We conducted a prospective, longitudinal, observational study to

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Section: Discussionmentioning

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Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Modi

Rausch

et al. 2014

Neurology

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“…Another study evaluated valproate monotherapy in 84 children with new-onset IGE and reported seizure freedom in 57% with an additional 10 patients who achieved seizure freedom but had to discontinue valproate because of intolerable adverse events [59]. Table 4.…”

Section: Class IV Trialsmentioning

confidence: 98%

Treatment of idiopathic generalized epilepsy – a review of the evidence

Beydoun

D’Souza

2012

Expert Opinion on Pharmacotherapy

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Based on the reviewed data, there is strong evidence-based data to support the use of valproate and ethosuximide for the treatment of childhood absence seizures; for the use of topiramate as monotherapy or adjunctive therapy for patients with primarily generalized tonic-clonic seizures; for the use of adjunctive therapy with lamotrigine for the treatment of primarily generalized tonic-clonic seizures; and for the use of levetiracetam as adjunctive therapy for the treatment of myoclonic or primarily generalized tonic-clonic seizures. To evaluate a new drug as a potential treatment for patients with IGE requires a rational methodology, discussed in this review.

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“…Antiepileptic drugs (AEDs) are the primary treatment modality for most patients with epilepsy, and the overall goal of treatment is no seizures, no side effects and best quality of life (Glauser, 2002). Although multiple efficacious AEDs are available to treat children with epilepsy, one-third of children with newly diagnosed epilepsy continue to have seizures despite the use of an AED (Geerts et al, 2010;Holland & Glauser, 2007;Holland, Monahan, Morita, Vartzelis, & Glauser, 2010;Kwan & Brodie, 2000). The precise reason for experiencing continued seizures despite the use of medications is often unknown, but may be because of seizure type, disease etiology, genetics, medication selection/combination, underlying brain abnormalities, or AED nonadherence (Berg, Testa, & Levy, 2011;Geerts et al, 2012;Glauser et al, 2006;Modi, Ingerski, Rausch, & Glauser, 2011;.…”

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confidence: 99%