Abstracts

Rationale: Epilepsy is a common chronic medical condition encountered in pediatric medical care encountered during U.S. humanitarian assistance mission Enduring Promise 20181,. During this mission the USNS Comfort was deployed to South America and medical care was provided free of charge to patients in Esmeraldas, Ecuador. This article aims to describe anti-epileptic drug (AED) use observed by a child neurologist while practicing general pediatrics in Esmeraldas, Ecuador. Methods: While serving as a general pediatrician seeing patients between the ages of 1 days old and 25 years of age, 84 total patients were seen during 3 days of clinic. Ten children whom met the criteria for a diagnosis of epilepsy2 were examined between the ages of 7 months and 16 years, and AED choice was recorded. The following seizure phenotypes were classified and recorded:  2 patients had generalized onset epileptic spasms; 1 patient had generalized myoclonic seizures; 1 patient had generalized absence seizures; 1 patient had generalized tonic-clonic seizures; 6 patients had both cerebral palsy and focal onset seizures with impaired awareness. Patients typically obtained medications from the Ecuadorian Social Security Institute (IESS) or the Ministry of Public Health. Results: Valproic acid is overwhelmingly the drug of choice regardless of age and/or epilepsy phenotype, including in children less than 2 years of age, and in post pubescent teenagers. 100% of the patients were prescribed valproic acid. 1 patient was on both oxcarbazepine and valproic acid. 1 patient was prescribed both levetiracetam and valproic acid. Efforts were made to optimize dosing in patients for whom weight based adjustments had not been made. A new prescription was given for a female patient of child bearing age to transition from valproic acid to levetiracetam in order to minimize teratogenicity3. Conclusions: Valproic Acid is widely available in state run clinics and pharmacies and appears to be the drug of choice regardless of type of epilepsy identified in children in Esmeraldas Ecuador. Although second generation AED's including levetiracetam and oxcarbamazepine were prescribed and are available for purchase4, the authors did not find them widely used. It is unclear whether this represents a difficulty accessing specialty care versus difficulty obtaining the medication itself, as it has been reported that large proportions of patients with epilepsy in rural Ecuador were AED naïve5. Addressing state-run formularies may be helpful in providing access to a wider variety of anti-epileptic medications.References: - Folker C, Clark C, Winslow A, et al. Pediatric Outpatient Care During U.S. Humanitarian Assistance Operations in Response to Venezuelan and Central American Migration. Pediatric Academic Society Annual Meeting, Baltimore, MD, April 27-30, 2019. [platform] - Fisher R, Cross JH, French J et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology Epilepsia 2017; 58(4):522-530. - Hernández-Díaz S1, Smith CR, Shen A et al Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012 22;78(21):1692-9. - Commercial Pharmacy, Ecuador https://www.farmaciaseconomicas.com.ec/beneficios/medicinas-de-especialidad.html. Accessed June 9, 2019. - Placencia M, Sander JW, Roman M et al. The characteristics of epilepsy in a largely untreated population in rural Ecuador.J Neurol Neurosurg Psychiatry. 1994 57(3): 320-325. Funding: No funding