Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus

Renée A. Shellhaas*, Anne T. Berg, Zachary M. Grinspan, Courtney J. Wusthoff, John J. Millichap, Tobias Loddenkemper, Jason Coryell, Russell P. Saneto, Catherine J. Chu, Sucheta M. Joshi, Joseph E. Sullivan, Kelly G. Knupp, Eric H. Kossoff, Cynthia Keator, Elaine C. Wirrell, John R. Mytinger, Ignacio Valencia, Shavonne Massey, William D. Gaillard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective There are no evidence-based guidelines on the preferred approach to treating early-life epilepsy. We examined initial therapy selection in a contemporary US cohort of children with newly diagnosed, nonsyndromic, early-life epilepsy (onset before age three years). Methods Seventeen pediatric epilepsy centers participated in a prospective cohort study of children with newly diagnosed epilepsy with onset under 36 months of age. Details regarding demographics, seizure types, and initial medication selections were obtained from medical records. Results About half of the 495 enrolled children with new-onset, nonsyndromic epilepsy were less than 12 months old at the time of diagnosis (n = 263, 53%) and about half (n = 260, 52%) had epilepsy with focal features. Of 464 who were treated with monotherapy, 95% received one of five drugs: levetiracetam (n = 291, 63%), oxcarbazepine (n = 67, 14%), phenobarbital (n = 57, 12%), topiramate (n = 16, 3.4%), and zonisamide (n = 13, 2.8%). Phenobarbital was prescribed first for 50 of 163 (31%) infants less than six months old versus seven of 300 (2.3%) of children six months or older (P < 0.0001). Although the first treatment varied across study centers (P < 0.0001), levetiracetam was the most commonly prescribed medication regardless of epilepsy presentation (focal, generalized, mixed/uncertain). Between the first and second treatment choices, 367 (74%) of children received levetiracetam within the first year after diagnosis. Conclusions Without any specific effort, the pediatric epilepsy community has developed an unexpectedly consistent approach to initial treatment selection for early-life epilepsy. This suggests that a standard practice is emerging and could be utilized as a widely acceptable basis of comparison in future drug studies.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalPediatric neurology
StatePublished - Oct 2017


  • antiepileptic drugs
  • epilepsy
  • focal seizures
  • generalized seizures
  • levetiracetam
  • oxcarbazepine
  • phenobarbital

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Developmental Neuroscience
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus'. Together they form a unique fingerprint.

Cite this