Evidence map›Paper›PMID 28807611›Full record

ArticlePediatric neurology2017

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 and 9 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric neurology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 18 institutions in 1 country.

Renée A ShellhaasDepartment of Pediatrics, University of Michigan, Ann Arbor, Michigan. Electronic address: shellhaa@med.umich.edu.
Anne T BergEpilepsy Center, Lurie Children's Hospital; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Zachary M GrinspanWeill Cornell Medicine; New York Presbyterian Hospital; Health Information Technology Evaluation Collaborative, New York, New York.
Courtney J WusthoffDivision of Child Neurology, Stanford University, Palo Alto, California.
John J MillichapEpilepsy Center, Lurie Children's Hospital; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Tobias LoddenkemperDivision of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Jason CoryellDepartments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, Oregon.
Russell P SanetoDivision of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Catherine J ChuDepartment of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
Sucheta M JoshiDepartment of Pediatrics, University of Michigan, Ann Arbor, Michigan.
Joseph E SullivanDepartment of Neurology, University of California San Francisco, San Francisco, California.
Kelly G KnuppDepartment of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Eric H KossoffDepartments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.
Cynthia KeatorCook Children's Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, Texas.
Elaine C WirrellDepartment of Neurology, Mayo Clinic, Rochester, Minnesota.
John R MytingerDepartment of Pediatrics, the Ohio State University; Nationwide Children's Hospital, Columbus, Ohio.
Ignacio ValenciaSection of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Shavonne MasseyDepartments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
William D GaillardDepartment of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia.
University of Michigan–Ann Arbor · USChildren's National · USCook Children's Health Care System · USHarvard University · USJohns Hopkins Hospital · USLurie Children's Hospital · USMassachusetts General Hospital · USMayo Clinic · USNationwide Children's Hospital · USOregon Health & Science University · USPresbyterian Hospital · USRobert H. Lurie Comprehensive Cancer Center of Northwestern UniversitySeattle Children's Hospital · USStanford University · USSt. Christopher's Hospital for Children · USUniversity of California, San Francisco · USUniversity of Colorado Anschutz Medical Campus · USUniversity of Pennsylvania · US

Funding

WCMC Child Neurology Postdoctoral Training on Developmental NeurosciencesK12NS066274 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI KOSOFSKY, BARRY E · 2010 to 2019
$2.8M
Identification of Cortical Biomarkers for Seizure Risk in Childhood EpilepsyK23NS092923 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI CHU, CATHERINE J · 2015 to 2020
$1.0M
NINDS NIH HHS K12 NS066274NINDS NIH HHS K23 NS092923
6 · The paper itself

Abstract

objectiveThere 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).

methodsSeventeen 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.

resultsAbout 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.

conclusionsWithout 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.

Indexed as

AnticonvulsantsChild, PreschoolDrug Therapy, CombinationEpilepsyFemaleHumansInfantMaleRetrospective StudiesTreatment OutcomeAnticonvulsantsantiepileptic drugsepilepsyfocal seizuresgeneralized seizureslevetiracetamoxcarbazepinephenobarbital

Identifiers

PMID28807611
PMCPMC5863237
OpenAlexW2728781949

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.