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 the shortcomings by using the expert consensus method, and conducted the first European survey in pediatrics., Forty-two pediatric epilepsy experts completed the Pediatric Epilepsy Consensus Survey. The experts answered 33 questions, with 418 possible answers. Topics addressed were 1) overall treatment strategy (sequencing both drug and non-pharmacologic treatment) for common childhood epilepsies; and, 2) specific treatment choices for common childhood epilepsies., Valproate was the drug of choice and the only agent felt to be first line therapy for the treatment of symptomatic myoclonic and generalized tonic clonic seizures. Vigabatrin was the drug of choice for infantile spasm secondary to tuberous sclerosis complex (TSC) and for symptomatic infantile spasms. 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 and lamotrigine were considered first line therapy. Valproate was the first choice for treatment of childhood absence epilepsy (CAE), whereas ethosuximide and lamotrigine were considered first line choices. Valproate was the drug of choice for juvenile absence epilepsy, and lamotrigine was a first line choice. Valproate was the only first line agent and considered the drug of choice for the treatment of benign rolandic epilepsy of childhood. Carbamazepine, oxcarbazepine, and valproate were all considered first line choices to treat cryptogenic complex partial seizures of childhood. Valproate and lamotrigine were considered first line agents to treat juvenile myoclonic epilepsy in an adolescent male or female. Rectal diazepam was the first choice for the acute treatment of a febrile seizure, while valproate was considered the first choice for preventative therapy. The treatment sequence for either complex partial or generalized tonic clonic status epilepticus (S.E.) was either intravenous (IV) diazepam or lorazepam, followed by IV phenytoin or fosphenytoin, if needed. The treatment sequence for absence SE was IV diazepam, followed by IV valproate, if needed. Phenobarbital was the first choice in treating neonatal seizures., The results of the first European 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, and Shire.)