Trends in Pediatric Epilepsy Prescriptions Are Identified

When prescribing home seizure rescue medications, pediatric neurologists most frequently choose rectal diazepam to treat prolonged seizures and clonazepam oral disintegrating tablets to treat clusters of seizures, according to results of a survey completed by members of the Pediatric Epilepsy Research Consortium (PERC).

To assess the seizure rescue medication prescribing practices among pediatric neurologists for patients of different age groups, cognitive abilities, and seizure types, the researchers sent a brief survey via email to 76 PERC members. In all, 36 members anonymously completed the survey.

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“Rectal diazepam was the most commonly chosen rescue medication for a prolonged convulsive seizure in a severely developmentally delayed 16-year-old (44%) and typical and delayed 7-year-old (44% and 61%, respectively), 3-year-old (78% and 86%, respectively), and 9-month-old (83%) patients,” the researchers wrote.

Respondents also would most commonly prescribe rectal diazepam (69%) to severely developmentally delayed 16-year-olds. However, most respondents (66%) reported that they would instead prescribe intranasal midazolam to a developmentally typical 16-year-old. 

For the treatment of clusters of seizures, clonazepam oral disintegrating tablets were reported to be the most commonly used first-line option in nearly all age groups. However, rectal diazepam was chosen more often than the oral tablets for children who were aged 3 years or 9 months and were developmentally delayed.

With the exception of a few cases, respondents followed the standard dosing guidelines.

“Further work is necessary to establish best practices for type and administration route of seizure rescue medications,” the researchers concluded. 

—Colleen Murphy

Reference:

Wallace A, Wirrell E, Payne E. Seizure rescue medication use among US pediatric epilepsy providers: a survey of the Pediatric Epilepsy Research Consortium. J Pediatr. 2019;212:111-116. doi:10.1016/j.jpeds.2019.05.034.