Pharmacotherapy of Focal Epilepsy in Children: A Systematic Review of Approved Agents
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Partial-onset seizures contribute the bulk of seizure burden in childhood epilepsy. The therapeutic decision making involves consideration of factors specific to drug, patient and socioeconomic situation.
This paper systematically reviews the available efficacy/effectiveness evidence for various anti-epileptic drugs (AED) as monotherapy and adjunctive therapy for partial-onset seizures in children.
Relevant randomized clinical trials (RCTs) were identified by a structured PubMed search, supplemented by an additional hand search of reference lists and authors’ files.
Study appraisal and synthesis methods
Eligible studies were reviewed and data extracted into tables. Included RCTs were classified based on accepted published criteria.
Only efficacy and effectiveness outcome measures were evaluated since there is little scientifically rigorous comprehensive AED adverse effects data.
Oxcarbazepine is the only AED with Class I evidence for efficacy/effectiveness as initial monotherapy for partial-onset seizures in children. Carbamazepine, clobazam, lamotrigine, phenobarbital, phenytoin, topiramate, valproate, vigabatrin and zonisamide have, at best, Class III efficacy/effectiveness evidence for monotherapy of partial-onset seizures in children. For adjunctive therapy, gabapentin, lamotrigine, levetiracetam, oxcarbazepine and topiramate have Class I efficacy/effectiveness evidence for treatment of pediatric partial-onset seizures.
Conclusions and implications of key findings
This efficacy/effectiveness analysis must not be used in isolation when selecting therapy. AED selection for a specific child needs to integrate a drug’s efficacy/effectiveness data with its safety and tolerability profile, pharmacokinetic properties, available formulations, and patient specific characteristics. It is critical that physicians and patients incorporate all these relevant variables when choosing AED therapy.
The authors wish to acknowledge the assistance of Lisa C. Garrity, Pharm D; for review and comments on the manuscript. None of the authors received any funding for authorship or publication of this manuscript. R.A. did the literature search, data extraction, data synthesis and wrote the manuscript. T.A.G. provided the concept and overall organization for the review article and edited the manuscript. Both authors approved the final version. Dr. Arya has no conflict of interest to disclose. Dr. Glauser is funded by multiple NIH grants. He has received consulting fees from Supernus, Sunovion, Eisai, UCB, Lundbeck and Questcor, and is on the speakers’ bureau of Eisai and Questcor. He serves as an expert consultant for the US Department of Justice. He is a consultant for and receives royalties from a patent license from AssureRx Health.
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