New research, 'Treatment of pediatric epilepsy: European expert opinion, 2007,' is the subject of a report (see also Life Sciences). 'Childhood epilepsies are a heterogeneous group of conditions that differ in diagnostic criteria and management and have dramatically different outcomes. Despite increasing data on treatment of epilepsy, research findings on childhood epilepsy are more limited and many clinical questions remain unanswered, so that clinicians must often rely on clinical judgment,' researchers in the United States report.
'In such clinical situations, expert opinion can be especially helpful. A survey on pediatric epilepsy and seizures (33 questions and approximately 650 treatment options) was sent to 57 European physicians specializing in pediatric epilepsy, 42 (74%) of whom completed it. In some questions, the experts were asked to recommend overall treatment approaches for specific syndromes (the order in which they would use certain strategies). Most of the questions asked the experts to rate options using a modified version of the RAND 9-point scale for medical appropriateness. Consensus was defined as a non-random distribution of scores by chi-square test, with ratings used to assign a categorical rank (first line/usually appropriate, second line/equivocal, and third line/usually not appropriate) to each option. Valproate was treatment of choice for symptomatic myoclonic and generalized tonic-clonic seizures. For initial monotherapy for complex partial seizures, carbamazepine and oxcarbazepine were treatments of choice, with valproate also first line. As initial therapy for infantile spasms caused by tuberous sclerosis, viagabatrin was treatment of choice. As initial therapy for infantile spasms that are symptomatic in etiology, vigabatrin was also treatment of choice, with adrenocorticotropic hormone (ACTH) and prednisone other first-line options. As initial therapy for Lennox-Gastaut syndrome, valproate was treatment of choice. For acute treatment of a prolonged febrile seizure or cluster of seizures, rectal diazepam was treatment of choice. Valproate was treatment of choice as preventive therapy for febrile seizures. For benign childhood epilepsy with centro-temporal spikes, valproate was treatment of choice. For childhood and juvenile absence epilepsy, valproate was treatment of choice, with lamotrigine another first-line option (ethosuximide was another first-line option for childhood absence epilepsy). For juvenile myoclonic epilepsy in adolescent males, valproate was treatment of choice, with lamotrigine another first-line option; for juvenile myoclonic epilepsy in adolescent females, lamotrigine was treatment of choice, with valproate another firstline option. As initial therapy for neonatal status epilepticus, intravenous (IV) phenobarbital was treatment of choice. As initial therapy for all types of pediatric status epilepticus, IV diazepam was treatment of choice. For generalized tonic-clonic status epilepticus, rectal diazepam and IV lorazepam were also treatments of choice; for complex partial status epilepticus, IV lorazepam was another first-line option. The expert panel reached consensus on many treatment options. Within the limits of expert opinion and with the understanding that new research data may take precedence, the experts' recommendations provide helpful guidance in situations where the medical literature is scant or lacking,' wrote J.W. Wheless and colleagues, University of Tennessee, Health Science Center.
The researchers concluded: 'The information in this report should be evaluated in conjunction with evidence-based findings.'
Wheless and colleagues published their study in Epileptic Disorders (Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disorders, 2007;9(4):353-412).
For additional information, contact J.W. Wheless, University of Tennessee Health Science Center, Division of Pediatric Neurology, Le Bonheur Comprehensive Epilepsy Program, Memphis, TN 38105 USA..
Publisher contact information for the journal Epileptic Disorders is: John Libbey Eurotext Ltd., 127 Avenue de La Republique, 92120 Montrouge, France.
Keywords: United States, Memphis, Life Sciences, Pediatric, Neurology, Genetics, Tuberous Sclerosis, Infantile Spasm, Central Nervous System Disease, Epilepsy, Seizures, Carbamazepine, Pharmaceuticals, Drugs, Therapy, Treatment, Oxcarbazepine, Vigabatrin, Anticonvulsant, Enzyme Inhibitor, Diagnostics.
This article was prepared by Health & Medicine Week editors from staff and other reports. Copyright 2008, Health & Medicine Week via NewsRx.com.