"Rethinking" the use of anti-epileptic drugs after children with epilepsy are discharged from the hospital

A new study showed that after 24 months of age were treated with antiepileptic drugs (ASMs) in the hospital, there was no difference in functional neurodevelopment or epilepsy regardless of whether they continued to use ASMs after discharge.
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This result was recently published on JAMA Neurology.

Edited by Yimaitong, please do not reprint without authorization.

Research Introduction Scholars from Canada conducted a prospective, observational, multi-center comparative effectiveness study.
The study included 303 newborn children with acute symptomatic epilepsy born between July 2015 and March 2018.

The male infants in the study accounted for 56%, slightly more than female infants.

 The researchers used conventional EEG to continuously monitor the condition of the children, and administer and treat them under the advice of local medical staff.

The researchers collected data on the types of antiepileptic drugs used, the timing and dosage of drug withdrawal or maintenance, and analyzed the demographic, clinical, and causes of primary epilepsy.

The parents of these children are required to report the children’s neurodevelopmental results at 12 months, 18 months, and 24 months, and the results should be verified by medical records.

The main result of the study was the functional neurodevelopment at 24 months.

 Among 303 infants, 43% of seizures were caused by hypoxic-ischemic encephalopathy, 26% were caused by ischemic stroke, 18% were caused by intracranial hemorrhage, and the remaining 13% were caused by another type of acute brain injury.

 In 90% of infants, the first antiepileptic drug is phenobarbital.

Most of the children (64%) were still using antiepileptic drugs at discharge (P<0.
001).

Anti-epileptic drug maintenance is more common in infants with high epileptic burden, complicated clinical course, and abnormal neurological function at discharge.

In children with continuous medication, the average treatment time of anti-epileptic drugs was 4 months, while in infants who discontinued the drug, the average treatment time of anti-epileptic drugs was 6 days.

 Among 270 24-month-old children, the median score on the WIDEA-FS questionnaire was 164, which was slightly higher than the score of 2% for children who discontinued the drug before discharge.

However, the researchers observed no significant differences in functional neurodevelopment or epilepsy between the two cohorts at 24 months.

 Discussion Hannah C.
Glass, director of the neonatal intensive care unit at the Benioff Children’s Hospital at the University of California, San Francisco, and colleagues pointed out that these results support the discontinuation of antiepileptic drugs for most newborns with acute symptomatic seizures before discharge.
This method may represent an evidence-based change in practice by many clinicians.

Out of concerns about persistent seizures and early life epilepsy, they said that after discharge from the hospital, it is unnecessary for babies to continue to use anti-epileptic drugs for months or years.

 For this reason, the results of the study show that continuing to take anti-epileptic drugs after discharge from the hospital does not protect the baby from persistent seizures or prevent epilepsy, nor does it change the results of functional neurodevelopment.

Most of the children in this study were eager to take anti-epileptic drugs after returning home, which indicates that we need to reconsider standard treatment.

 References: [1] Study:'Rethink' use of antiseizure medications after hospital discharge in neonates – Healio News – May 26, 2021[2] Glass HC et al.
Safety of Early Discontinuation of Antiseizure Medication After Acute Symptomatic Neonatal Seizures.
JAMA Neurol.
doi:10.
1001/jamaneurol.
2021.
1437