First-line antiseizure medications equally effective in routine paediatric care

In the first-line treatment of newly diagnosed childhood epilepsy, antiseizure medications (ASMs) such as oxcarbazepine, valproate, levetiracetam, topiramate, and lamotrigine perform similarly, with no notable difference in outcomes, according to a retrospective cohort study.

Researchers analysed 10 years of electronic medical records from Shenzhen Children’s Hospital. They identified 7,060 children who initiated monotherapy with oxcarbazepine, valproate, levetiracetam, topiramate, or lamotrigine.

Treatment success, the primary outcome, was defined as sustained seizure and side effect freedom at the defined analytic endpoint. Outcomes based on the 2010 International League Against Epilepsy (ILAE) definition were also assessed. Multivariable Cox regression and stabilized inverse probability of treatment weighting were applied in the analyses.

Over a median follow-up of 14.0 months, 47.9 percent of patients achieved treatment success and 48.3 percent met the ILAE criteria. The median seizure- and side effect-free survival was 24.8 months (95 percent confidence interval [CI], 23.3–26.5).

The most prescribed ASMs were oxcarbazepine (32.3 percent), valproate (31.7 percent), and levetiracetam (22.5 percent).

Treatment success was similar across ASM types or age groups. Significant predictors of treatment failure were epileptic spasms (hazard ratio [HR], 2.86, 95 percent CI, 1.98–4.09), generalized seizures (HR, 1.78, 95 percent CI, 1.49–2.13), seizures before reaching maintenance dose (HR, 1.52, 95 percent CI, 1.37–1.70), delayed treatment initiation (3 months to 1 year vs ≤3 months: HR, 1.40, 95 percent CI, 1.26–1.56), and neurodevelopmental delay (HR, 1.42, 95 percent CI, 1.26–1.60).

These findings indicate that the effectiveness of ASMs seems to be consistent in paediatric epilepsy, regardless of age group.