Nav: Home

Alternative treatment for epileptic seizures in children identified

May 07, 2019

A new study published in The Lancet, involving researchers from the University of Liverpool and Alder Hey Children's Hospital Trust, has identified a 'user friendly' treatment for the most common life-threatening neurological emergency in children.

Every day in the UK, 87 people are diagnosed with epilepsy, affecting over 600,000 people. Many people with a new diagnosis of epilepsy will experience memory and other cognitive problems. The cause of these problems is unknown.

It has an annual incidence of 20 per 100?000 children, and is the second most common reason for unplanned admissions to paediatric intensive care units (PICUs) in the UK.

Anti-epileptic drugs (AEDs), also known as anticonvulsants, are used to control seizures in people with epilepsy.

Convulsive status epilepticus (CSE) is the situation when a tonic-clonic seizure doesn't stop either on its own or with anticonvulsants. It is the most common life-threatening neurological emergency in children.

Currently, CSE is treated using an algorithm which incorporates 10 min intervals between treatments. Second-line treatment is given when CSE persists either after two doses of the first-line treatment, which is an anticonvulsant called a benzodiazepine, or the child's personalised emergency (rescue) treatment.

The anticonvulsant medication phenytoin has been used as the usual second-line treatment of CSE for several decades and is known to have rare but potentially dangerous side effects. However, some evidence suggests that another medication, levetiracetam could be an effective and safer alternative. To ascertain which treatment was safest and most effective the EcLiPSE Team, made up of doctors from Alder Hey and Bristol Children's Hospitals together with research teams from the Universities of Liverpool and the West of England, conducted a trial to compare the efficacy and safety of both drugs for second-line management of CSE.

The EcLiPSE Team is led by Professor Richard Appleton, a Merseyside paediatric neurologist based at the University of Liverpool's Department of Women's and Children's Health, and Alder Hey Children's Hospital Trust.

Between 2014 and 2018 the team conducted a randomised clinical trial involving 30 UK Emergency Departments and almost 300 children.

The results did not show that levetiracetam was better than phenytoin, in stopping CSE. However, overall the results suggest levetiracetam may be considered as an alternative treatment to phenytoin.

Professor Richard Appleton, said: "The EcLiPSE trial has given doctors new and unique evidence for the choice of anticonvulsant and how to best treat this childhood neurological emergency.

"Our results suggest that levetiracetam could be considered as an alternative treatment to phenytoin for second-line management of paediatric CSE. Possible benefits of levetiracetam over phenytoin include its ease of preparation and administration, minimal interaction with antiepilepsy and other drugs, and easy conversion to oral maintenance therapy. Further randomised clinical trial and meta-analysis data could help to confirm our results and might lead to levetiracetam being the preferred second-line anticonvulsant in children with benzodiazepine-resistant convulsive status epilepticus.

"The trial also highlights the importance of close and effective collaboration between two specialities in paediatrics, neurology and emergency medicine that will improve the care of children with epilepsy."
-end-
The study was supported by PERUKI (Paediatric Emergency Research in the UK and Ireland) and funded by the National Institute for Health Research (NIHR) HTA (Health Technology Assessment) programme.

The full paper, entitled 'Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial, can be found here https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30724-X/fulltext

University of Liverpool

Related Epilepsy Articles:

Breaching the brain's defense causes epilepsy
Epileptic seizures can happen to anyone. But how do they occur and what initiates such a rapid response?
Using connectomics to understand epilepsy
Abnormalities in structural brain networks and how brain regions communicate may underlie a variety of disorders, including epilepsy, which is one focus of a two-part Special Issue on the Brain Connectome in Brain Connectivity, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.
Epilepsy: Triangular relationship in the brain
When an epileptic seizure occurs in the brain, the nerve cells lose their usual pattern and fire in a very fast rhythm.
How concussions may lead to epilepsy
Researchers have identified a cellular response to repeated concussions that may contribute to seizures in mice like those observed following traumatic brain injury in humans.
Understanding epilepsy in pediatric tumors
A KAIST research team led by Professor Jeong Ho Lee of the Graduate School of Medical Science and Engineering has recently identified a neuronal BRAF somatic mutation that causes intrinsic epileptogenicity in pediatric brain tumors.
Can medical marijuana help treat intractable epilepsy?
A new British Journal of Clinical Pharmacology review examines the potential of medicinal cannabis -- or medical marijuana -- for helping patients with intractable epilepsy, in which seizures fail to come under control with standard anticonvulsant treatment.
Fertility rates no different for women with epilepsy
'Myth-busting' study among women with no history of infertility finds that those with epilepsy are just as likely to become pregnant as those without.
Do women with epilepsy have similar likelihood of pregnancy?
Women with epilepsy without a history of infertility or related disorders who wanted to become pregnant were about as likely as their peers without epilepsy to become pregnant.
Hope for new treatment of severe epilepsy
Researchers at Lund University in Sweden believe they have found a method that in the future could help people suffering from epilepsy so severe that all current treatment is ineffective.
Many epilepsy patients take drug combinations that interact
In an Epilepsia analysis of 2008-2010 Medicare claims data, one in four older Americans with new-onset epilepsy and more than one-third with prevalent epilepsy received a combination of antiepileptic drugs and non-epilepsy drugs that could interact to alter the effectiveness of the non-epilepsy drugs.
More Epilepsy News and Epilepsy Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab