Abstracts

Rationale: To describe characteristics and treatment variability in patients with new onset epilepsy.Methods: Retrospective descriptive study of new onset epilepsy patients at Boston Children’s Hospital during the year of 2013. Patients with a clinical diagnosis of epilepsy as supported by history, EEG or syndrome diagnosis were included. Patients diagnosed at a different institution, not followed at BCH after 3 months from diagnosis, or not treated with any antiepileptic drugs were excluded.Results: 193 newly diagnosed patients with epilepsy (106 (54.9%) males, 87 (45.1%) females) were followed for a median of 16 months (range: 7-27 months). Median age at onset was 7 years (range: 0-19 years). 39 (20.2%) patients had pre or perinatal complications and 38 (19.7%) had prior provoked seizure history. A family history of seizures was found in 54 (28%) patients. Epilepsy localizations were determined by EEG and MRI findings and they were generalized in 116 (60.1%), focal in 66 (34.2%) and multifocal in 11 (5.7%) patients (Table 1). At time of epilepsy diagnosis, treatment was started in 193 patients, with levetiracetam as the most frequent first treatment choice in 113 patients. Other first treatments included: oxcarbazepine (30), ethosuximide (22), ACTH (8), lamotrigine (7), valproate (5), phenobarbital (2), topiramate (2), vigabatrin (2), carbamazepine (1) and clonazepam (1). At the time of patients’ first follow-up following epilepsy diagnosis (median 16 weeks, range: 6-34 weeks), 169 (87.6%) patients were on their first treatment choice. The median maximum seizure free duration for patients still on their first treatment choice was 13 weeks (range: 0-32 weeks). 24 patients discontinued the first treatment due to adverse effects in 12/24 (50%), therapeutic failure in 6/24 (25%) and therapeutic success in 6/24 (25%) with ACTH as the first treatment choice in all 6 therapeutic success cases. At latest available follow-up (median 16 months, range: 7-27 months), 138 (71.5%) patients continued their first treatment choice. The median maximum seizure free duration for patients who were on their first treatment choice was 13 months (range: 0-27 months). 55 patients discontinued their first line treatment due to adverse effects in 23/55 (41.8%), therapeutic failure in 24/55 (43.6%) and 8/55 (14.6%) patients who were treated with ACTH, as their first treatment choice discontinued following therapeutic success.Conclusions: This study describes initial presentation characteristics, first treatment choices and the reasons for discontinuation of first treatment choice in new onset epilepsy patients. Most patients became seizure free on their first treatment choice and remained on this treatment choice at a median follow up of 16 months.