Antiseizure Medication In Children With New-Onset Epilepsies: First-Drug Efficacy, Drug Failure, and Drug-Resistant Rates In A Multicenter Large Cohort

Objective. In this multicenter cohort study we evaluated the effectiveness of first choice of ASM in children with new-onset epilrpsy. Method. A retrospective cohort study was conducted on a cohort consisted of 946 new-onset epileptic children from four pediatric epilepsy centers. Early seizure outcome of first-drug of ASM was defined at 6th month of therapy with a seizure-free rate with respect to seizure semiology and etiology (structural versus unknown). Results. Seizure semiology was focal-onset in 507 (54%) and generalized-onset in 439 (46%) of the cohort (the mean age was 7 years (IQR:3-10), female:423 and male:533, the mean duration of follow-up: 21±13 months). At 6th month of therapy, 635 (66%) patient has seizure free achievement with first ASM monotherapy. The drug failure was defined in 291 (29%) patients with inadequate seizure control and /or drug withdrawal due to adverse events in 20 (2%) patients. Adjunctive therapy was initiated in 311 patients with dual therapy in 174 (18%) and polytherapy in 137 (15%). We also compared first two most commonly selected first ASMs (levetiracetam in 332 patients versus valproate in 387 patients). Similar rates were defined for levetirasetam and valproate in terms of drug failure (33% vs 35%) and drug resistance epilepsy (15% vs 14%) Conclusion. The present study has demonstrated that the majority of patients achieved seizure freedom by taking a single antiepileptic drug. Only one third of patients had treatment failure with first ASM monotherapy. antiseizure medication; efficacy;tolerability.