Doug Brunk

A higher proportion of youth with epilepsy reports more bouts of loneliness and problems in social relationships compared with their healthy peers, results from a large Norwegian study showed.

The findings underscore the importance of asking youth with epilepsy about the impact the condition has on their lives, Dr. Kristin Alfstad said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "To get them to open up: I often ask, ‘How do you like school? Are things okay at school?’ If they don’t function well in school, that’s often a sign of trouble. I’ll also ask them, ‘Do you have a best friend?’ "

Doug Brunk/IMNG Medical Media

Dr. Alfstad, a neurologist with the division of surgery and clinical neuroscience at Oslo University Hospital, Norway, and her associates previously published data showing a higher prevalence of symptoms of psychological distress and risk-taking behavior in youth with epilepsy compared with controls (Epilepsia 2011;52:1231-8; Acta. Neurol. Scand. Suppl. 2011;191:12-7). The purpose of the current analysis was to investigate how youth with epilepsy aged 16-19 years perceive their social relationships.

The researchers analyzed survey responses from 10,571 youth who were asked in 2002 to describe their feelings concerning social relationships. Questions could be answered as correct, partly correct, or not correct, and the researchers used chi-square analysis for testing categorical variables.

Next, they conducted a multivariate analysis, with feeling lonely as the dependent variable and having/having had epilepsy, gender, low family income, and living with a single parent as independent risk factors.

Of the 10,571 respondents, 114 reported having or having had epilepsy (1.2%). Compared with controls, a higher proportion of youth with epilepsy identified with the question: "I cannot choose whom I want to make friends with" (13.2% vs. 7.1%; P = .012), and "I have a feeling that nobody knows me well" (11.6% vs. 6.8%; P = .045). In addition, a higher proportion of youth with epilepsy stated that they felt lonely (10.7%, compared with 5.5% among controls).

Multivariate analysis revealed that low family income was the strongest predictor of feeling lonely (odds ratio 2.3; P less than .001), followed by having/having had epilepsy (OR 2.0; P = .026), female gender (OR 1.4; P less than .001), and living with a single parent (OR 1.3; P = .019).

The study was funded by the Norwegian Institute of Public Health. Dr. Alfstad said she had no relevant financial disclosures.

d.brunk@elsevier.com

A higher proportion of youth with epilepsy reports more bouts of loneliness and problems in social relationships compared with their healthy peers, results from a large Norwegian study showed.

The findings underscore the importance of asking youth with epilepsy about the impact the condition has on their lives, Dr. Kristin Alfstad said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "To get them to open up: I often ask, ‘How do you like school? Are things okay at school?’ If they don’t function well in school, that’s often a sign of trouble. I’ll also ask them, ‘Do you have a best friend?’ "

Doug Brunk/IMNG Medical Media

Dr. Alfstad, a neurologist with the division of surgery and clinical neuroscience at Oslo University Hospital, Norway, and her associates previously published data showing a higher prevalence of symptoms of psychological distress and risk-taking behavior in youth with epilepsy compared with controls (Epilepsia 2011;52:1231-8; Acta. Neurol. Scand. Suppl. 2011;191:12-7). The purpose of the current analysis was to investigate how youth with epilepsy aged 16-19 years perceive their social relationships.

The researchers analyzed survey responses from 10,571 youth who were asked in 2002 to describe their feelings concerning social relationships. Questions could be answered as correct, partly correct, or not correct, and the researchers used chi-square analysis for testing categorical variables.

Next, they conducted a multivariate analysis, with feeling lonely as the dependent variable and having/having had epilepsy, gender, low family income, and living with a single parent as independent risk factors.

Of the 10,571 respondents, 114 reported having or having had epilepsy (1.2%). Compared with controls, a higher proportion of youth with epilepsy identified with the question: "I cannot choose whom I want to make friends with" (13.2% vs. 7.1%; P = .012), and "I have a feeling that nobody knows me well" (11.6% vs. 6.8%; P = .045). In addition, a higher proportion of youth with epilepsy stated that they felt lonely (10.7%, compared with 5.5% among controls).

Multivariate analysis revealed that low family income was the strongest predictor of feeling lonely (odds ratio 2.3; P less than .001), followed by having/having had epilepsy (OR 2.0; P = .026), female gender (OR 1.4; P less than .001), and living with a single parent (OR 1.3; P = .019).

The study was funded by the Norwegian Institute of Public Health. Dr. Alfstad said she had no relevant financial disclosures.

d.brunk@elsevier.com

A higher proportion of youth with epilepsy reports more bouts of loneliness and problems in social relationships compared with their healthy peers, results from a large Norwegian study showed.

The findings underscore the importance of asking youth with epilepsy about the impact the condition has on their lives, Dr. Kristin Alfstad said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "To get them to open up: I often ask, ‘How do you like school? Are things okay at school?’ If they don’t function well in school, that’s often a sign of trouble. I’ll also ask them, ‘Do you have a best friend?’ "

Doug Brunk/IMNG Medical Media

Dr. Alfstad, a neurologist with the division of surgery and clinical neuroscience at Oslo University Hospital, Norway, and her associates previously published data showing a higher prevalence of symptoms of psychological distress and risk-taking behavior in youth with epilepsy compared with controls (Epilepsia 2011;52:1231-8; Acta. Neurol. Scand. Suppl. 2011;191:12-7). The purpose of the current analysis was to investigate how youth with epilepsy aged 16-19 years perceive their social relationships.

The researchers analyzed survey responses from 10,571 youth who were asked in 2002 to describe their feelings concerning social relationships. Questions could be answered as correct, partly correct, or not correct, and the researchers used chi-square analysis for testing categorical variables.

Next, they conducted a multivariate analysis, with feeling lonely as the dependent variable and having/having had epilepsy, gender, low family income, and living with a single parent as independent risk factors.

Of the 10,571 respondents, 114 reported having or having had epilepsy (1.2%). Compared with controls, a higher proportion of youth with epilepsy identified with the question: "I cannot choose whom I want to make friends with" (13.2% vs. 7.1%; P = .012), and "I have a feeling that nobody knows me well" (11.6% vs. 6.8%; P = .045). In addition, a higher proportion of youth with epilepsy stated that they felt lonely (10.7%, compared with 5.5% among controls).

Multivariate analysis revealed that low family income was the strongest predictor of feeling lonely (odds ratio 2.3; P less than .001), followed by having/having had epilepsy (OR 2.0; P = .026), female gender (OR 1.4; P less than .001), and living with a single parent (OR 1.3; P = .019).

The study was funded by the Norwegian Institute of Public Health. Dr. Alfstad said she had no relevant financial disclosures.

d.brunk@elsevier.com

SAN DIEGO – A home-based intervention that incorporated components of mindfulness and cognitive-behavioral therapy led to the prevention of depression, a reduction in seizures, and increased life satisfaction, a randomized study of patients with epilepsy demonstrated.

"Reports are that 32%-48% of people with epilepsy experience depression," Nancy J. Thompson, Ph.D., said at the annual meeting of the American Epilepsy Society. "We know clinically that people with epilepsy may avoid antidepressants because of their epilepsy medications, but at the same time psychotherapy attendance is limited by driving restrictions, so a great number of people with epilepsy and depression go untreated."

The intervention, known as Project UPLIFT, was created at Emory University with funding from the Centers for Disease Control and Prevention as a home-based intervention to address depression in people with epilepsy. The acronym stands for Using Practice, which is a reference to mindfulness, and Learning to Increase Favorable Thoughts, which is a reference to cognitive-behavioral therapy (CBT).

"CBT teaches people to notice how their thoughts and their mood are related and to challenge and in some cases change their thoughts," said Dr. Thompson, a psychologist with the Rollins School of Public Health at Emory University, Atlanta, who helped originate the intervention. "Mindfulness-based cognitive therapy takes it a step further and teaches people to let thoughts pass, which is a little bit less of a cognitive burden and part of why we chose to use mindfulness-based cognitive therapy."

UPLIFT is delivered to groups of seven people by Web or by telephone over the course of eight hour-long sessions. "In our initial study, both the Web and telephone were more effective than treatment as usual in reducing symptoms of depression for people with epilepsy," Dr. Thompson said.

For the current analysis, which was funded by the National Institute on Minority Health and Health Disparities, the researchers recruited 130 patients from clinics at Emory; the University of Michigan, Ann Arbor; the University of Texas Health Science Center, Houston; and the University of Washington, Seattle. The intervention was delivered from Emory by trainees in the mental health program and cofacilitated by a person with epilepsy. Dr. Thompson supervised all of the sessions.

"We randomized people to the intervention or to the treatment-as-usual condition," she said. "Then we allowed them to choose their preferred means of delivery. Everyone got the intervention at some point in time."

Dr. Thompson presented results from 108 patients: 52 in the intervention group and 56 in the treatment-as-usual group. Study participants were adults with epilepsy who had been diagnosed for at least 3 months. They had mild to moderate symptoms of depression but did not meet criteria for major depressive disorder. They had no suicidal ideation and were mentally stable. The measures of interest included knowledge and skills gained in the program, their coping self-efficacy, and their self-compassion. The outcomes evaluated were depression based on the modified Beck Depression Inventory (mBDI), the Patient Health Questionnaire–9 (PHQ-9), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); seizures based on the self-reported number of seizures and the Liverpool Seizure Severity Scale, and quality of life as measured by the Short Form 36 Physical and Mental QOL and the Satisfaction With Life Scale.

Dr. Thompson reported that 11% in the treatment-as-usual group developed major depressive disorder compared with none in the intervention group (P = .028). Compared with their counterparts in the treatment-as-usual group, those in the intervention group also had better scores on the mBDI (P = .005), the PHQ-9 (P = .049), knowledge/skills (P = .043), the Satisfaction With Life Scale (P = .006), seizure severity (P = .10), and the number of seizures (P = .025).

The researchers observed a dose-response relationship between the number of sessions attended and the mean change in depression, number of seizures, knowledge and skills, and satisfaction with life. "All other measures changed in the expected direction, although they did not achieve significance," she said. "The effects were maintained over the 8 weeks of follow-up."

The intervention "constituted a leap forward in the delivery of depression treatment," Dr. Thompson concluded. "It reaches those whose mobility is impaired by disability, or even the fatigue and loss of energy associated with depression. It also reaches people in rural or otherwise hard-to-reach areas. Those with specific conditions who live far apart can be brought together in a group to connect and share experiences."

She also noted that the study demonstrates the efficacy of UPLIFT as a preventive intervention. It "averts disability and lost productivity from depression, eliminates tangible and intangible costs of treating depression, and provides participants with skills to manage future stress and difficult life circumstances."

The cost effectiveness of the intervention will be a focus of future analyses, she said.

Dr. Thompson said she had no relevant financial disclosures.

d.brunk@elsevier.com

SAN DIEGO – A home-based intervention that incorporated components of mindfulness and cognitive-behavioral therapy led to the prevention of depression, a reduction in seizures, and increased life satisfaction, a randomized study of patients with epilepsy demonstrated.

"Reports are that 32%-48% of people with epilepsy experience depression," Nancy J. Thompson, Ph.D., said at the annual meeting of the American Epilepsy Society. "We know clinically that people with epilepsy may avoid antidepressants because of their epilepsy medications, but at the same time psychotherapy attendance is limited by driving restrictions, so a great number of people with epilepsy and depression go untreated."

The intervention, known as Project UPLIFT, was created at Emory University with funding from the Centers for Disease Control and Prevention as a home-based intervention to address depression in people with epilepsy. The acronym stands for Using Practice, which is a reference to mindfulness, and Learning to Increase Favorable Thoughts, which is a reference to cognitive-behavioral therapy (CBT).

"CBT teaches people to notice how their thoughts and their mood are related and to challenge and in some cases change their thoughts," said Dr. Thompson, a psychologist with the Rollins School of Public Health at Emory University, Atlanta, who helped originate the intervention. "Mindfulness-based cognitive therapy takes it a step further and teaches people to let thoughts pass, which is a little bit less of a cognitive burden and part of why we chose to use mindfulness-based cognitive therapy."

UPLIFT is delivered to groups of seven people by Web or by telephone over the course of eight hour-long sessions. "In our initial study, both the Web and telephone were more effective than treatment as usual in reducing symptoms of depression for people with epilepsy," Dr. Thompson said.

For the current analysis, which was funded by the National Institute on Minority Health and Health Disparities, the researchers recruited 130 patients from clinics at Emory; the University of Michigan, Ann Arbor; the University of Texas Health Science Center, Houston; and the University of Washington, Seattle. The intervention was delivered from Emory by trainees in the mental health program and cofacilitated by a person with epilepsy. Dr. Thompson supervised all of the sessions.

"We randomized people to the intervention or to the treatment-as-usual condition," she said. "Then we allowed them to choose their preferred means of delivery. Everyone got the intervention at some point in time."

Dr. Thompson presented results from 108 patients: 52 in the intervention group and 56 in the treatment-as-usual group. Study participants were adults with epilepsy who had been diagnosed for at least 3 months. They had mild to moderate symptoms of depression but did not meet criteria for major depressive disorder. They had no suicidal ideation and were mentally stable. The measures of interest included knowledge and skills gained in the program, their coping self-efficacy, and their self-compassion. The outcomes evaluated were depression based on the modified Beck Depression Inventory (mBDI), the Patient Health Questionnaire–9 (PHQ-9), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); seizures based on the self-reported number of seizures and the Liverpool Seizure Severity Scale, and quality of life as measured by the Short Form 36 Physical and Mental QOL and the Satisfaction With Life Scale.

Dr. Thompson reported that 11% in the treatment-as-usual group developed major depressive disorder compared with none in the intervention group (P = .028). Compared with their counterparts in the treatment-as-usual group, those in the intervention group also had better scores on the mBDI (P = .005), the PHQ-9 (P = .049), knowledge/skills (P = .043), the Satisfaction With Life Scale (P = .006), seizure severity (P = .10), and the number of seizures (P = .025).

The researchers observed a dose-response relationship between the number of sessions attended and the mean change in depression, number of seizures, knowledge and skills, and satisfaction with life. "All other measures changed in the expected direction, although they did not achieve significance," she said. "The effects were maintained over the 8 weeks of follow-up."

The intervention "constituted a leap forward in the delivery of depression treatment," Dr. Thompson concluded. "It reaches those whose mobility is impaired by disability, or even the fatigue and loss of energy associated with depression. It also reaches people in rural or otherwise hard-to-reach areas. Those with specific conditions who live far apart can be brought together in a group to connect and share experiences."

She also noted that the study demonstrates the efficacy of UPLIFT as a preventive intervention. It "averts disability and lost productivity from depression, eliminates tangible and intangible costs of treating depression, and provides participants with skills to manage future stress and difficult life circumstances."

The cost effectiveness of the intervention will be a focus of future analyses, she said.

Dr. Thompson said she had no relevant financial disclosures.

d.brunk@elsevier.com

SAN DIEGO – A home-based intervention that incorporated components of mindfulness and cognitive-behavioral therapy led to the prevention of depression, a reduction in seizures, and increased life satisfaction, a randomized study of patients with epilepsy demonstrated.

"Reports are that 32%-48% of people with epilepsy experience depression," Nancy J. Thompson, Ph.D., said at the annual meeting of the American Epilepsy Society. "We know clinically that people with epilepsy may avoid antidepressants because of their epilepsy medications, but at the same time psychotherapy attendance is limited by driving restrictions, so a great number of people with epilepsy and depression go untreated."

The intervention, known as Project UPLIFT, was created at Emory University with funding from the Centers for Disease Control and Prevention as a home-based intervention to address depression in people with epilepsy. The acronym stands for Using Practice, which is a reference to mindfulness, and Learning to Increase Favorable Thoughts, which is a reference to cognitive-behavioral therapy (CBT).

"CBT teaches people to notice how their thoughts and their mood are related and to challenge and in some cases change their thoughts," said Dr. Thompson, a psychologist with the Rollins School of Public Health at Emory University, Atlanta, who helped originate the intervention. "Mindfulness-based cognitive therapy takes it a step further and teaches people to let thoughts pass, which is a little bit less of a cognitive burden and part of why we chose to use mindfulness-based cognitive therapy."

UPLIFT is delivered to groups of seven people by Web or by telephone over the course of eight hour-long sessions. "In our initial study, both the Web and telephone were more effective than treatment as usual in reducing symptoms of depression for people with epilepsy," Dr. Thompson said.

For the current analysis, which was funded by the National Institute on Minority Health and Health Disparities, the researchers recruited 130 patients from clinics at Emory; the University of Michigan, Ann Arbor; the University of Texas Health Science Center, Houston; and the University of Washington, Seattle. The intervention was delivered from Emory by trainees in the mental health program and cofacilitated by a person with epilepsy. Dr. Thompson supervised all of the sessions.

"We randomized people to the intervention or to the treatment-as-usual condition," she said. "Then we allowed them to choose their preferred means of delivery. Everyone got the intervention at some point in time."

Dr. Thompson presented results from 108 patients: 52 in the intervention group and 56 in the treatment-as-usual group. Study participants were adults with epilepsy who had been diagnosed for at least 3 months. They had mild to moderate symptoms of depression but did not meet criteria for major depressive disorder. They had no suicidal ideation and were mentally stable. The measures of interest included knowledge and skills gained in the program, their coping self-efficacy, and their self-compassion. The outcomes evaluated were depression based on the modified Beck Depression Inventory (mBDI), the Patient Health Questionnaire–9 (PHQ-9), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); seizures based on the self-reported number of seizures and the Liverpool Seizure Severity Scale, and quality of life as measured by the Short Form 36 Physical and Mental QOL and the Satisfaction With Life Scale.

Dr. Thompson reported that 11% in the treatment-as-usual group developed major depressive disorder compared with none in the intervention group (P = .028). Compared with their counterparts in the treatment-as-usual group, those in the intervention group also had better scores on the mBDI (P = .005), the PHQ-9 (P = .049), knowledge/skills (P = .043), the Satisfaction With Life Scale (P = .006), seizure severity (P = .10), and the number of seizures (P = .025).

The researchers observed a dose-response relationship between the number of sessions attended and the mean change in depression, number of seizures, knowledge and skills, and satisfaction with life. "All other measures changed in the expected direction, although they did not achieve significance," she said. "The effects were maintained over the 8 weeks of follow-up."

The intervention "constituted a leap forward in the delivery of depression treatment," Dr. Thompson concluded. "It reaches those whose mobility is impaired by disability, or even the fatigue and loss of energy associated with depression. It also reaches people in rural or otherwise hard-to-reach areas. Those with specific conditions who live far apart can be brought together in a group to connect and share experiences."

She also noted that the study demonstrates the efficacy of UPLIFT as a preventive intervention. It "averts disability and lost productivity from depression, eliminates tangible and intangible costs of treating depression, and provides participants with skills to manage future stress and difficult life circumstances."

The cost effectiveness of the intervention will be a focus of future analyses, she said.

Dr. Thompson said she had no relevant financial disclosures.

d.brunk@elsevier.com

The U.S. Food and Drug Administration announced Jan. 10 new, lower dosing requirements for certain sleep drugs that contain zolpidem, including Ambien, Ambien CR, Edluar, and ZolpiMist. Ambien and Ambien CR are also available as generics. The move comes on the heels of new data from driving simulation and laboratory studies showing that zolpidem blood levels in some individuals may be high enough the morning after use to impair activities that require alertness, including driving.

"After analyzing these new data we felt it necessary to add new drug safety information to the labeling, including lowering of the recommended dose," Dr. Ellis Unger, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research, said during a Jan. 10 teleconference. "We hope that use of lower doses of zolpidem will mean that less drug will be in the bloodstream in the morning hours. We urge health care professionals to caution all patients who use these products about the risks of next morning impairment for activities that require complete mental alertness."

For women, the FDA now recommends that the dose of zolpidem should be lowered from 10 mg to 5 mg for immediate-release products and from 12.5 mg to 6.25 mg for extended-release products. (Ambien and Ambien CR are also available as generics.) "We have learned rather recently that women appear to be more susceptible to the risk of next morning impairment, because they eliminate zolpidem more slowly from their bodies than men," Dr. Unger said, noting that reasons for this association remain unclear. The supposition that women are smaller in size, compared with men, "is the first thing that one would think of," he said. "But if you correct the drug level data for patient size, that doesn’t account for the difference between men and women [in how the drug is eliminated]." For men, the FDA advises health care professionals to consider these same lower doses (5 mg for immediate-release products and 6.25 mg for extended release products).

More details about the development can be found in a Drug Safety Communication that was issued concomitantly. Despite the new recommendations, Dr. Unger emphasized that patients who are currently taking the higher doses of these sleep drugs "should continue to take the drug as it’s been prescribed until they discuss their situation with their health care provider and figure out how to continue to take the medication safely. We know that each patient is unique. The appropriate dose should be discussed with their health care professional."

Dr. Unger also explained that next morning impairment is not limited to sleep drugs that contain zolpidem. "All sleep drugs have the potential to cause this," he said. "So for all sleep medications all health care professionals should prescribe the lowest dose that is capable of preventing insomnia. The lower doses will decrease the potential for next morning impairment. Patients who must drive the next morning or perform other activities requiring full alertness should talk to their health care professional about whether sleep medicine is appropriate for them."

He concluded his remarks by noting that the FDA is continuing to evaluate the risk of impaired mental alertness with other insomnia drugs, including those sold over the counter.

d.brunk@elsevier.com

The U.S. Food and Drug Administration announced Jan. 10 new, lower dosing requirements for certain sleep drugs that contain zolpidem, including Ambien, Ambien CR, Edluar, and ZolpiMist. Ambien and Ambien CR are also available as generics. The move comes on the heels of new data from driving simulation and laboratory studies showing that zolpidem blood levels in some individuals may be high enough the morning after use to impair activities that require alertness, including driving.

"After analyzing these new data we felt it necessary to add new drug safety information to the labeling, including lowering of the recommended dose," Dr. Ellis Unger, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research, said during a Jan. 10 teleconference. "We hope that use of lower doses of zolpidem will mean that less drug will be in the bloodstream in the morning hours. We urge health care professionals to caution all patients who use these products about the risks of next morning impairment for activities that require complete mental alertness."

For women, the FDA now recommends that the dose of zolpidem should be lowered from 10 mg to 5 mg for immediate-release products and from 12.5 mg to 6.25 mg for extended-release products. (Ambien and Ambien CR are also available as generics.) "We have learned rather recently that women appear to be more susceptible to the risk of next morning impairment, because they eliminate zolpidem more slowly from their bodies than men," Dr. Unger said, noting that reasons for this association remain unclear. The supposition that women are smaller in size, compared with men, "is the first thing that one would think of," he said. "But if you correct the drug level data for patient size, that doesn’t account for the difference between men and women [in how the drug is eliminated]." For men, the FDA advises health care professionals to consider these same lower doses (5 mg for immediate-release products and 6.25 mg for extended release products).

More details about the development can be found in a Drug Safety Communication that was issued concomitantly. Despite the new recommendations, Dr. Unger emphasized that patients who are currently taking the higher doses of these sleep drugs "should continue to take the drug as it’s been prescribed until they discuss their situation with their health care provider and figure out how to continue to take the medication safely. We know that each patient is unique. The appropriate dose should be discussed with their health care professional."

Dr. Unger also explained that next morning impairment is not limited to sleep drugs that contain zolpidem. "All sleep drugs have the potential to cause this," he said. "So for all sleep medications all health care professionals should prescribe the lowest dose that is capable of preventing insomnia. The lower doses will decrease the potential for next morning impairment. Patients who must drive the next morning or perform other activities requiring full alertness should talk to their health care professional about whether sleep medicine is appropriate for them."

He concluded his remarks by noting that the FDA is continuing to evaluate the risk of impaired mental alertness with other insomnia drugs, including those sold over the counter.

d.brunk@elsevier.com

The U.S. Food and Drug Administration announced Jan. 10 new, lower dosing requirements for certain sleep drugs that contain zolpidem, including Ambien, Ambien CR, Edluar, and ZolpiMist. Ambien and Ambien CR are also available as generics. The move comes on the heels of new data from driving simulation and laboratory studies showing that zolpidem blood levels in some individuals may be high enough the morning after use to impair activities that require alertness, including driving.

"After analyzing these new data we felt it necessary to add new drug safety information to the labeling, including lowering of the recommended dose," Dr. Ellis Unger, director of the Office of Drug Evaluation in the FDA’s Center for Drug Evaluation and Research, said during a Jan. 10 teleconference. "We hope that use of lower doses of zolpidem will mean that less drug will be in the bloodstream in the morning hours. We urge health care professionals to caution all patients who use these products about the risks of next morning impairment for activities that require complete mental alertness."

For women, the FDA now recommends that the dose of zolpidem should be lowered from 10 mg to 5 mg for immediate-release products and from 12.5 mg to 6.25 mg for extended-release products. (Ambien and Ambien CR are also available as generics.) "We have learned rather recently that women appear to be more susceptible to the risk of next morning impairment, because they eliminate zolpidem more slowly from their bodies than men," Dr. Unger said, noting that reasons for this association remain unclear. The supposition that women are smaller in size, compared with men, "is the first thing that one would think of," he said. "But if you correct the drug level data for patient size, that doesn’t account for the difference between men and women [in how the drug is eliminated]." For men, the FDA advises health care professionals to consider these same lower doses (5 mg for immediate-release products and 6.25 mg for extended release products).

More details about the development can be found in a Drug Safety Communication that was issued concomitantly. Despite the new recommendations, Dr. Unger emphasized that patients who are currently taking the higher doses of these sleep drugs "should continue to take the drug as it’s been prescribed until they discuss their situation with their health care provider and figure out how to continue to take the medication safely. We know that each patient is unique. The appropriate dose should be discussed with their health care professional."

Dr. Unger also explained that next morning impairment is not limited to sleep drugs that contain zolpidem. "All sleep drugs have the potential to cause this," he said. "So for all sleep medications all health care professionals should prescribe the lowest dose that is capable of preventing insomnia. The lower doses will decrease the potential for next morning impairment. Patients who must drive the next morning or perform other activities requiring full alertness should talk to their health care professional about whether sleep medicine is appropriate for them."

He concluded his remarks by noting that the FDA is continuing to evaluate the risk of impaired mental alertness with other insomnia drugs, including those sold over the counter.

d.brunk@elsevier.com

SAN DIEGO – People on Medicaid have a high incidence and prevalence of epilepsy, in an order of magnitude greater than that reported in the U.S. general population, results from a large analysis demonstrated.

This indigent population "carries a disproportionate amount of the epilepsy burden and therefore deserves more attention for their health care needs and support services," Dr. Kitti Kaiboriboon said in an interview at the annual meeting of the American Epilepsy Society, where the work was presented.

Few studies have shown that people with low socioeconomic status have a higher incidence and prevalence of epilepsy than their counterparts with high socioeconomic status, said Dr. Kaiboriboon, a neurologist in the epilepsy center at University Hospitals Case Medical Center, Cleveland.

"However, no study, to our knowledge, has specifically examined the incidence and/or prevalence of epilepsy in the Medicaid population, which are among the sickest and the poorest group of people in the United States," he said. "They have [a] high incidence and prevalence of chronic medical conditions, some of which are risk factors for epilepsy. The incidence and prevalence of epilepsy in this population are very important for public health planning."

The incidence and prevalence of epilepsy in the general population vary from study to study, he said, but the incidence of epilepsy in the United States usually ranges between 15 and 71/100,000 person-years, while the prevalence usually ranges between 5 and 9/1,000 persons.

Dr. Kaiboriboon and his associates obtained Ohio Medicaid claims data for adults between 1992 and 2006 to identify prevalent and incident cases of epilepsy. Prevalent cases of epilepsy were defined as those that had two or more claims of epilepsy or three or more claims of convulsion and two or more claims of antiepileptic drugs. Each of the diagnosis or pharmacy claims had to be more than 30 days apart. Incident cases of epilepsy were required to have no epilepsy or convulsion claims for at least 5 years before epilepsy was diagnosed. The researchers also determined which subjects had a preexisting disability and/or comorbid conditions including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury when at least one of these conditions occurred prior to the onset of epilepsy.

Dr. Kaiboriboon presented findings from 9,056 prevalent cases and 1,608 incident cases of epilepsy. The incidence of epilepsy in the Medicaid population was 360/ 100,000 person-years. "There are about 60 million people in the Medicaid population; you would expect to have 216,000 new cases of epilepsy each year," he said. "We found that the prevalence of epilepsy was 13.2/1,000 persons, which means that there are 792,000 Medicaid beneficiaries with epilepsy," he said. "This is huge."

The researchers found that the majority of Medicaid beneficiaries with epilepsy have preexisting medical and/or psychological conditions, with the most common being depression (773 cases), developmental disorders (436 cases), and stroke (422 cases). They also found that among people with preexisting conditions, people with brain tumor, traumatic brain injury, and stroke have the highest risk of developing epilepsy (risks of 78%, 76%, and 70%, respectively).

Dr. Kaiboriboon acknowledged certain limitations of the study, including the fact that it relied on Medicaid claims data to obtain the incidence and prevalence of epilepsy. "The case ascertainment, therefore, was mainly based on diagnosis codes," he said. "We, however, used very stringent criteria to identify subjects with epilepsy. Also, subjects who in fact had epilepsy but were not actively taking AEDs [antiepileptic drugs] would not be included in the analysis. Because of this, our incidence and prevalence are the estimates for ‘treated’ epilepsy."

The study was funded by the Epilepsy Foundation and by a grant from the National Center for Research Resources. Dr. Kaiboriboon said he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – People on Medicaid have a high incidence and prevalence of epilepsy, in an order of magnitude greater than that reported in the U.S. general population, results from a large analysis demonstrated.

This indigent population "carries a disproportionate amount of the epilepsy burden and therefore deserves more attention for their health care needs and support services," Dr. Kitti Kaiboriboon said in an interview at the annual meeting of the American Epilepsy Society, where the work was presented.

Few studies have shown that people with low socioeconomic status have a higher incidence and prevalence of epilepsy than their counterparts with high socioeconomic status, said Dr. Kaiboriboon, a neurologist in the epilepsy center at University Hospitals Case Medical Center, Cleveland.

"However, no study, to our knowledge, has specifically examined the incidence and/or prevalence of epilepsy in the Medicaid population, which are among the sickest and the poorest group of people in the United States," he said. "They have [a] high incidence and prevalence of chronic medical conditions, some of which are risk factors for epilepsy. The incidence and prevalence of epilepsy in this population are very important for public health planning."

The incidence and prevalence of epilepsy in the general population vary from study to study, he said, but the incidence of epilepsy in the United States usually ranges between 15 and 71/100,000 person-years, while the prevalence usually ranges between 5 and 9/1,000 persons.

Dr. Kaiboriboon and his associates obtained Ohio Medicaid claims data for adults between 1992 and 2006 to identify prevalent and incident cases of epilepsy. Prevalent cases of epilepsy were defined as those that had two or more claims of epilepsy or three or more claims of convulsion and two or more claims of antiepileptic drugs. Each of the diagnosis or pharmacy claims had to be more than 30 days apart. Incident cases of epilepsy were required to have no epilepsy or convulsion claims for at least 5 years before epilepsy was diagnosed. The researchers also determined which subjects had a preexisting disability and/or comorbid conditions including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury when at least one of these conditions occurred prior to the onset of epilepsy.

Dr. Kaiboriboon presented findings from 9,056 prevalent cases and 1,608 incident cases of epilepsy. The incidence of epilepsy in the Medicaid population was 360/ 100,000 person-years. "There are about 60 million people in the Medicaid population; you would expect to have 216,000 new cases of epilepsy each year," he said. "We found that the prevalence of epilepsy was 13.2/1,000 persons, which means that there are 792,000 Medicaid beneficiaries with epilepsy," he said. "This is huge."

The researchers found that the majority of Medicaid beneficiaries with epilepsy have preexisting medical and/or psychological conditions, with the most common being depression (773 cases), developmental disorders (436 cases), and stroke (422 cases). They also found that among people with preexisting conditions, people with brain tumor, traumatic brain injury, and stroke have the highest risk of developing epilepsy (risks of 78%, 76%, and 70%, respectively).

Dr. Kaiboriboon acknowledged certain limitations of the study, including the fact that it relied on Medicaid claims data to obtain the incidence and prevalence of epilepsy. "The case ascertainment, therefore, was mainly based on diagnosis codes," he said. "We, however, used very stringent criteria to identify subjects with epilepsy. Also, subjects who in fact had epilepsy but were not actively taking AEDs [antiepileptic drugs] would not be included in the analysis. Because of this, our incidence and prevalence are the estimates for ‘treated’ epilepsy."

The study was funded by the Epilepsy Foundation and by a grant from the National Center for Research Resources. Dr. Kaiboriboon said he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – People on Medicaid have a high incidence and prevalence of epilepsy, in an order of magnitude greater than that reported in the U.S. general population, results from a large analysis demonstrated.

This indigent population "carries a disproportionate amount of the epilepsy burden and therefore deserves more attention for their health care needs and support services," Dr. Kitti Kaiboriboon said in an interview at the annual meeting of the American Epilepsy Society, where the work was presented.

Few studies have shown that people with low socioeconomic status have a higher incidence and prevalence of epilepsy than their counterparts with high socioeconomic status, said Dr. Kaiboriboon, a neurologist in the epilepsy center at University Hospitals Case Medical Center, Cleveland.

"However, no study, to our knowledge, has specifically examined the incidence and/or prevalence of epilepsy in the Medicaid population, which are among the sickest and the poorest group of people in the United States," he said. "They have [a] high incidence and prevalence of chronic medical conditions, some of which are risk factors for epilepsy. The incidence and prevalence of epilepsy in this population are very important for public health planning."

The incidence and prevalence of epilepsy in the general population vary from study to study, he said, but the incidence of epilepsy in the United States usually ranges between 15 and 71/100,000 person-years, while the prevalence usually ranges between 5 and 9/1,000 persons.

Dr. Kaiboriboon and his associates obtained Ohio Medicaid claims data for adults between 1992 and 2006 to identify prevalent and incident cases of epilepsy. Prevalent cases of epilepsy were defined as those that had two or more claims of epilepsy or three or more claims of convulsion and two or more claims of antiepileptic drugs. Each of the diagnosis or pharmacy claims had to be more than 30 days apart. Incident cases of epilepsy were required to have no epilepsy or convulsion claims for at least 5 years before epilepsy was diagnosed. The researchers also determined which subjects had a preexisting disability and/or comorbid conditions including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury when at least one of these conditions occurred prior to the onset of epilepsy.

Dr. Kaiboriboon presented findings from 9,056 prevalent cases and 1,608 incident cases of epilepsy. The incidence of epilepsy in the Medicaid population was 360/ 100,000 person-years. "There are about 60 million people in the Medicaid population; you would expect to have 216,000 new cases of epilepsy each year," he said. "We found that the prevalence of epilepsy was 13.2/1,000 persons, which means that there are 792,000 Medicaid beneficiaries with epilepsy," he said. "This is huge."

The researchers found that the majority of Medicaid beneficiaries with epilepsy have preexisting medical and/or psychological conditions, with the most common being depression (773 cases), developmental disorders (436 cases), and stroke (422 cases). They also found that among people with preexisting conditions, people with brain tumor, traumatic brain injury, and stroke have the highest risk of developing epilepsy (risks of 78%, 76%, and 70%, respectively).

Dr. Kaiboriboon acknowledged certain limitations of the study, including the fact that it relied on Medicaid claims data to obtain the incidence and prevalence of epilepsy. "The case ascertainment, therefore, was mainly based on diagnosis codes," he said. "We, however, used very stringent criteria to identify subjects with epilepsy. Also, subjects who in fact had epilepsy but were not actively taking AEDs [antiepileptic drugs] would not be included in the analysis. Because of this, our incidence and prevalence are the estimates for ‘treated’ epilepsy."

The study was funded by the Epilepsy Foundation and by a grant from the National Center for Research Resources. Dr. Kaiboriboon said he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Adults who are diagnosed with epilepsy at 60 years or older face challenges and perceived negative life changes that are unique from those who are diagnosed at a younger age, especially in terms of managing medications and maintaining independence. The findings come from a qualitative study intended to describe problems and life changes faced by patients who receive an epilepsy diagnosis in later life.

"People aged 60 and older are at the highest risk for new-onset epilepsy," Wendy R. Miller, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "We’ve only recognized this trend in the last 10-15 years. No one has really studied this population to find out how they cope with epilepsy self-management compared with younger people."

For the study, which was carried out in 2011, Dr. Miller and her colleague, Janice Buelow, Ph.D., interviewed 20 patients who had a diagnosis of epilepsy at or after age 60. Eligibility criteria included having had a diagnosis of epilepsy for at least 6 months, being on at least one antiepileptic medication, and being community dwelling. During face-to-face semi-structured interviews, the researchers asked participants open-ended questions about problems and perceived changes they had experienced since being diagnosed with epilepsy.

Of the 20 patients, 12 were women, mean age was 70 years, and they were a mean of 4.1 years removed from their initial epilepsy diagnosis, according to Dr. Miller of the Indiana University School of Nursing, Indianapolis. Key problem areas reported by the study participants included maintaining independence (40% expressed concerns about transportation while 80% worried about their ability to continue life normally) and medications (95% were concerned about side effects of antiepileptic medications, 60% worried about remembering to take them, and 55% worried about their ability to afford them). "Many of the people interviewed have tight financial concerns," Dr. Miller said. "There were also polypharmacy issues, where people elected not to take their antiepilepsy medication because they perceived that it was not as important as their heart medication."

The majority of negative changes reported by the study participants were related to lifestyle, including impact on daily function (100%), physical and emotional symptoms (100%), impact on the number of commitments made (80%), relationships with family and friends (60%), and their ability to fulfill age-appropriate roles and responsibilities (60%).

While not reported in the abstract, another common concern expressed by study participants was related to the process of being diagnosed with epilepsy. "Many were initially misdiagnosed," Dr. Miller said. "It was really difficult for them to get an accurate diagnosis. I didn’t anticipate that. When I sat down with them for interviews that’s what they wanted to talk about, and that wasn’t even one of my questions. They would go from doctor to doctor, or the doctor would say that the seizures are due to a condition they already have. So they would go long periods of time without being treated."

The top two positive changes related to their epilepsy diagnosis as reported by study participants were perspective (25%) and impact on spirituality (25%). Dr. Miller said that she plans to use the study findings to develop an assessment tool to guide the development and implementation of tailored epilepsy self-management interventions for older adults. "This is a very unique group," Dr. Miller said. "They have unique needs, and they’re a growing segment of the population, so we have to devise interventions that are specific for them."

The study was funded by the National Institutes of Health. Dr. Miller said that she had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Adults who are diagnosed with epilepsy at 60 years or older face challenges and perceived negative life changes that are unique from those who are diagnosed at a younger age, especially in terms of managing medications and maintaining independence. The findings come from a qualitative study intended to describe problems and life changes faced by patients who receive an epilepsy diagnosis in later life.

"People aged 60 and older are at the highest risk for new-onset epilepsy," Wendy R. Miller, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "We’ve only recognized this trend in the last 10-15 years. No one has really studied this population to find out how they cope with epilepsy self-management compared with younger people."

For the study, which was carried out in 2011, Dr. Miller and her colleague, Janice Buelow, Ph.D., interviewed 20 patients who had a diagnosis of epilepsy at or after age 60. Eligibility criteria included having had a diagnosis of epilepsy for at least 6 months, being on at least one antiepileptic medication, and being community dwelling. During face-to-face semi-structured interviews, the researchers asked participants open-ended questions about problems and perceived changes they had experienced since being diagnosed with epilepsy.

Of the 20 patients, 12 were women, mean age was 70 years, and they were a mean of 4.1 years removed from their initial epilepsy diagnosis, according to Dr. Miller of the Indiana University School of Nursing, Indianapolis. Key problem areas reported by the study participants included maintaining independence (40% expressed concerns about transportation while 80% worried about their ability to continue life normally) and medications (95% were concerned about side effects of antiepileptic medications, 60% worried about remembering to take them, and 55% worried about their ability to afford them). "Many of the people interviewed have tight financial concerns," Dr. Miller said. "There were also polypharmacy issues, where people elected not to take their antiepilepsy medication because they perceived that it was not as important as their heart medication."

The majority of negative changes reported by the study participants were related to lifestyle, including impact on daily function (100%), physical and emotional symptoms (100%), impact on the number of commitments made (80%), relationships with family and friends (60%), and their ability to fulfill age-appropriate roles and responsibilities (60%).

While not reported in the abstract, another common concern expressed by study participants was related to the process of being diagnosed with epilepsy. "Many were initially misdiagnosed," Dr. Miller said. "It was really difficult for them to get an accurate diagnosis. I didn’t anticipate that. When I sat down with them for interviews that’s what they wanted to talk about, and that wasn’t even one of my questions. They would go from doctor to doctor, or the doctor would say that the seizures are due to a condition they already have. So they would go long periods of time without being treated."

The top two positive changes related to their epilepsy diagnosis as reported by study participants were perspective (25%) and impact on spirituality (25%). Dr. Miller said that she plans to use the study findings to develop an assessment tool to guide the development and implementation of tailored epilepsy self-management interventions for older adults. "This is a very unique group," Dr. Miller said. "They have unique needs, and they’re a growing segment of the population, so we have to devise interventions that are specific for them."

The study was funded by the National Institutes of Health. Dr. Miller said that she had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Adults who are diagnosed with epilepsy at 60 years or older face challenges and perceived negative life changes that are unique from those who are diagnosed at a younger age, especially in terms of managing medications and maintaining independence. The findings come from a qualitative study intended to describe problems and life changes faced by patients who receive an epilepsy diagnosis in later life.

"People aged 60 and older are at the highest risk for new-onset epilepsy," Wendy R. Miller, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society. "We’ve only recognized this trend in the last 10-15 years. No one has really studied this population to find out how they cope with epilepsy self-management compared with younger people."

For the study, which was carried out in 2011, Dr. Miller and her colleague, Janice Buelow, Ph.D., interviewed 20 patients who had a diagnosis of epilepsy at or after age 60. Eligibility criteria included having had a diagnosis of epilepsy for at least 6 months, being on at least one antiepileptic medication, and being community dwelling. During face-to-face semi-structured interviews, the researchers asked participants open-ended questions about problems and perceived changes they had experienced since being diagnosed with epilepsy.

Of the 20 patients, 12 were women, mean age was 70 years, and they were a mean of 4.1 years removed from their initial epilepsy diagnosis, according to Dr. Miller of the Indiana University School of Nursing, Indianapolis. Key problem areas reported by the study participants included maintaining independence (40% expressed concerns about transportation while 80% worried about their ability to continue life normally) and medications (95% were concerned about side effects of antiepileptic medications, 60% worried about remembering to take them, and 55% worried about their ability to afford them). "Many of the people interviewed have tight financial concerns," Dr. Miller said. "There were also polypharmacy issues, where people elected not to take their antiepilepsy medication because they perceived that it was not as important as their heart medication."

The majority of negative changes reported by the study participants were related to lifestyle, including impact on daily function (100%), physical and emotional symptoms (100%), impact on the number of commitments made (80%), relationships with family and friends (60%), and their ability to fulfill age-appropriate roles and responsibilities (60%).

While not reported in the abstract, another common concern expressed by study participants was related to the process of being diagnosed with epilepsy. "Many were initially misdiagnosed," Dr. Miller said. "It was really difficult for them to get an accurate diagnosis. I didn’t anticipate that. When I sat down with them for interviews that’s what they wanted to talk about, and that wasn’t even one of my questions. They would go from doctor to doctor, or the doctor would say that the seizures are due to a condition they already have. So they would go long periods of time without being treated."

The top two positive changes related to their epilepsy diagnosis as reported by study participants were perspective (25%) and impact on spirituality (25%). Dr. Miller said that she plans to use the study findings to develop an assessment tool to guide the development and implementation of tailored epilepsy self-management interventions for older adults. "This is a very unique group," Dr. Miller said. "They have unique needs, and they’re a growing segment of the population, so we have to devise interventions that are specific for them."

The study was funded by the National Institutes of Health. Dr. Miller said that she had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Just over half of patients with epilepsy routinely take some form of supplements or alternative medications, results from a large single-center study showed.

"Supplement and alternative medicine use in patients with epilepsy is an understudied area of medicine," Dr. Kristen Kelly said in an interview following the annual meeting of the American Epilepsy Society, where the work was presented. "Our study is unique in that it was an anonymous survey, giving patients the freedom to respond without the physicians or anyone else knowing which patient was submitting the response," she said. "Also, this was performed in a large epilepsy clinic in Phoenix, Arizona, where a significant number of Hispanic patients receive care."

©GRAÇA VICTORIA/ISTOCKPHOTO.COM

During her neurology residency, Dr. Kelly and her associate, Dr. Steve S. Chung, surveyed 500 consecutive epilepsy patients at the Phoenix-based Barrow Neurological Institute about their supplement use. A majority of patients (87%) completed the survey, which was conducted between February and June 2012.

The duration of epilepsy was less than 1 year in 5% of patients, 1-5 years in 15% of patients, 5-10 years in 15% of patients, and more than 10 years in 65% of patients. Approximately 52% indicated that they took at least one alternative supplement.

A total of 202 respondents listed the specific supplements they used. The average number of supplements per person was 2.7, and the most common were multivitamins (51%), calcium (25%), vitamin D (23%), and fish oil (18%). There were 49 supplements named that were used by five or fewer people, and 33 supplements named that were each used by only one person. "Three patients in the survey listed marijuana as one of their supplements or alternative medication," said Dr. Kelly. "Two of the patients took it because they believed it helped their seizures, and one for reasons not related to the patient’s seizure disorder. I suspect this will become even more common among epilepsy patients in the future."

The study’s overall findings suggest that clinicians should ask epilepsy patients about their use of supplements or alternative medications, "because even well-recognized, common supplements can affect seizure medications," Dr. Kelly said. "In addition, many patients are taking uncommon supplements that physicians may need to investigate before deciding if the supplements have the potential to affect seizure control or seizure medications."

She acknowledged certain limitations of the study, including its anonymity and single-center design. "This did limit our data acquisition by not being able to review patient charts," she said. "There is also the risk of erroneous information given by a patient during any questionnaire-based study."

The researchers stated that they had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Just over half of patients with epilepsy routinely take some form of supplements or alternative medications, results from a large single-center study showed.

"Supplement and alternative medicine use in patients with epilepsy is an understudied area of medicine," Dr. Kristen Kelly said in an interview following the annual meeting of the American Epilepsy Society, where the work was presented. "Our study is unique in that it was an anonymous survey, giving patients the freedom to respond without the physicians or anyone else knowing which patient was submitting the response," she said. "Also, this was performed in a large epilepsy clinic in Phoenix, Arizona, where a significant number of Hispanic patients receive care."

©GRAÇA VICTORIA/ISTOCKPHOTO.COM

During her neurology residency, Dr. Kelly and her associate, Dr. Steve S. Chung, surveyed 500 consecutive epilepsy patients at the Phoenix-based Barrow Neurological Institute about their supplement use. A majority of patients (87%) completed the survey, which was conducted between February and June 2012.

The duration of epilepsy was less than 1 year in 5% of patients, 1-5 years in 15% of patients, 5-10 years in 15% of patients, and more than 10 years in 65% of patients. Approximately 52% indicated that they took at least one alternative supplement.

A total of 202 respondents listed the specific supplements they used. The average number of supplements per person was 2.7, and the most common were multivitamins (51%), calcium (25%), vitamin D (23%), and fish oil (18%). There were 49 supplements named that were used by five or fewer people, and 33 supplements named that were each used by only one person. "Three patients in the survey listed marijuana as one of their supplements or alternative medication," said Dr. Kelly. "Two of the patients took it because they believed it helped their seizures, and one for reasons not related to the patient’s seizure disorder. I suspect this will become even more common among epilepsy patients in the future."

The study’s overall findings suggest that clinicians should ask epilepsy patients about their use of supplements or alternative medications, "because even well-recognized, common supplements can affect seizure medications," Dr. Kelly said. "In addition, many patients are taking uncommon supplements that physicians may need to investigate before deciding if the supplements have the potential to affect seizure control or seizure medications."

She acknowledged certain limitations of the study, including its anonymity and single-center design. "This did limit our data acquisition by not being able to review patient charts," she said. "There is also the risk of erroneous information given by a patient during any questionnaire-based study."

The researchers stated that they had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Just over half of patients with epilepsy routinely take some form of supplements or alternative medications, results from a large single-center study showed.

"Supplement and alternative medicine use in patients with epilepsy is an understudied area of medicine," Dr. Kristen Kelly said in an interview following the annual meeting of the American Epilepsy Society, where the work was presented. "Our study is unique in that it was an anonymous survey, giving patients the freedom to respond without the physicians or anyone else knowing which patient was submitting the response," she said. "Also, this was performed in a large epilepsy clinic in Phoenix, Arizona, where a significant number of Hispanic patients receive care."

©GRAÇA VICTORIA/ISTOCKPHOTO.COM

During her neurology residency, Dr. Kelly and her associate, Dr. Steve S. Chung, surveyed 500 consecutive epilepsy patients at the Phoenix-based Barrow Neurological Institute about their supplement use. A majority of patients (87%) completed the survey, which was conducted between February and June 2012.

The duration of epilepsy was less than 1 year in 5% of patients, 1-5 years in 15% of patients, 5-10 years in 15% of patients, and more than 10 years in 65% of patients. Approximately 52% indicated that they took at least one alternative supplement.

A total of 202 respondents listed the specific supplements they used. The average number of supplements per person was 2.7, and the most common were multivitamins (51%), calcium (25%), vitamin D (23%), and fish oil (18%). There were 49 supplements named that were used by five or fewer people, and 33 supplements named that were each used by only one person. "Three patients in the survey listed marijuana as one of their supplements or alternative medication," said Dr. Kelly. "Two of the patients took it because they believed it helped their seizures, and one for reasons not related to the patient’s seizure disorder. I suspect this will become even more common among epilepsy patients in the future."

The study’s overall findings suggest that clinicians should ask epilepsy patients about their use of supplements or alternative medications, "because even well-recognized, common supplements can affect seizure medications," Dr. Kelly said. "In addition, many patients are taking uncommon supplements that physicians may need to investigate before deciding if the supplements have the potential to affect seizure control or seizure medications."

She acknowledged certain limitations of the study, including its anonymity and single-center design. "This did limit our data acquisition by not being able to review patient charts," she said. "There is also the risk of erroneous information given by a patient during any questionnaire-based study."

The researchers stated that they had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

Women aged 30 years and younger in the United States are undergoing cervical cancer screening in line with recent national recommendations, findings from a new report from the Centers for Disease Control and Prevention demonstrated.

For example, between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage of women aged 22-30 years who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

However, in what researchers described as an "unfavorable trend," the prevalence of women aged 22-30 years who reported having never been screened increased from 6.6% in 2000 to 9% in 2010. "More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening," researchers led by Dr. Mona Saraiya reported in the Jan. 4 edition of Morbidity and Mortality Weekly Report.

In 2012, recommendations from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force called for Pap screening to begin no earlier than age 21 and within an interval of 3 years between routine Pap tests for women aged 22-30 years. The purpose of the current analysis was to evaluate trends in Pap testing before the 2012 guidelines were introduced.

Dr. Saraiya, a medical officer in the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch, and her associates collected data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of adults aged 18 years and older (MMWR 2013;61:1038-42). Between 2000 and 2010, 125,297 female respondents in all 50 states and the District of Columbia were asked, "Have you ever had a Pap test?" The researchers analyzed Pap test status by age group, race/ethnicity, U.S. Census region, and health care coverage status.

Between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 65% to 41.5%. During the same time period, the percentage of women aged 22-30 years who reported never being screened increased from 6.6% to 9.0%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

The researchers acknowledged certain limitations of the survey, including the fact that the data were self-reported, and that it "did not consider whether Pap testing behaviors varied by human papillomavirus (HPV) vaccination status or by timing of sexual initiation."

In a separate study of BRFSS data from the same time period, CDC researchers led by Meg Watson, M.P.H., found that Pap test use among women aged 30 years and older who have had a hysterectomy decreased from 73.3% in 2000 to 58.7% in 2010, while recent Pap testing (within 3 years) decreased among women aged 65 years and older without a hysterectomy, from 73.5 % in 2000 to 64.5 % in 2010 (MMWR 2013;61:1043-7). However, women aged 30-64 years who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous 3 years – from 74.4 % in 2000 to 68.7 % in 2010.

"Women not receiving recommended screening and follow-up are at increased risk for cervical cancer mortality," the researchers noted. "Underscreening among women with less education, no usual source of health care, and no health care coverage is well documented and a persistent cause of health disparities."

Both studies were funded by the CDC.

Women aged 30 years and younger in the United States are undergoing cervical cancer screening in line with recent national recommendations, findings from a new report from the Centers for Disease Control and Prevention demonstrated.

For example, between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage of women aged 22-30 years who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

However, in what researchers described as an "unfavorable trend," the prevalence of women aged 22-30 years who reported having never been screened increased from 6.6% in 2000 to 9% in 2010. "More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening," researchers led by Dr. Mona Saraiya reported in the Jan. 4 edition of Morbidity and Mortality Weekly Report.

In 2012, recommendations from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force called for Pap screening to begin no earlier than age 21 and within an interval of 3 years between routine Pap tests for women aged 22-30 years. The purpose of the current analysis was to evaluate trends in Pap testing before the 2012 guidelines were introduced.

Dr. Saraiya, a medical officer in the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch, and her associates collected data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of adults aged 18 years and older (MMWR 2013;61:1038-42). Between 2000 and 2010, 125,297 female respondents in all 50 states and the District of Columbia were asked, "Have you ever had a Pap test?" The researchers analyzed Pap test status by age group, race/ethnicity, U.S. Census region, and health care coverage status.

Between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 65% to 41.5%. During the same time period, the percentage of women aged 22-30 years who reported never being screened increased from 6.6% to 9.0%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

The researchers acknowledged certain limitations of the survey, including the fact that the data were self-reported, and that it "did not consider whether Pap testing behaviors varied by human papillomavirus (HPV) vaccination status or by timing of sexual initiation."

In a separate study of BRFSS data from the same time period, CDC researchers led by Meg Watson, M.P.H., found that Pap test use among women aged 30 years and older who have had a hysterectomy decreased from 73.3% in 2000 to 58.7% in 2010, while recent Pap testing (within 3 years) decreased among women aged 65 years and older without a hysterectomy, from 73.5 % in 2000 to 64.5 % in 2010 (MMWR 2013;61:1043-7). However, women aged 30-64 years who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous 3 years – from 74.4 % in 2000 to 68.7 % in 2010.

"Women not receiving recommended screening and follow-up are at increased risk for cervical cancer mortality," the researchers noted. "Underscreening among women with less education, no usual source of health care, and no health care coverage is well documented and a persistent cause of health disparities."

Both studies were funded by the CDC.

Women aged 30 years and younger in the United States are undergoing cervical cancer screening in line with recent national recommendations, findings from a new report from the Centers for Disease Control and Prevention demonstrated.

For example, between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage of women aged 22-30 years who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

However, in what researchers described as an "unfavorable trend," the prevalence of women aged 22-30 years who reported having never been screened increased from 6.6% in 2000 to 9% in 2010. "More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening," researchers led by Dr. Mona Saraiya reported in the Jan. 4 edition of Morbidity and Mortality Weekly Report.

In 2012, recommendations from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force called for Pap screening to begin no earlier than age 21 and within an interval of 3 years between routine Pap tests for women aged 22-30 years. The purpose of the current analysis was to evaluate trends in Pap testing before the 2012 guidelines were introduced.

Dr. Saraiya, a medical officer in the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch, and her associates collected data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of adults aged 18 years and older (MMWR 2013;61:1038-42). Between 2000 and 2010, 125,297 female respondents in all 50 states and the District of Columbia were asked, "Have you ever had a Pap test?" The researchers analyzed Pap test status by age group, race/ethnicity, U.S. Census region, and health care coverage status.

Between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 65% to 41.5%. During the same time period, the percentage of women aged 22-30 years who reported never being screened increased from 6.6% to 9.0%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

The researchers acknowledged certain limitations of the survey, including the fact that the data were self-reported, and that it "did not consider whether Pap testing behaviors varied by human papillomavirus (HPV) vaccination status or by timing of sexual initiation."

In a separate study of BRFSS data from the same time period, CDC researchers led by Meg Watson, M.P.H., found that Pap test use among women aged 30 years and older who have had a hysterectomy decreased from 73.3% in 2000 to 58.7% in 2010, while recent Pap testing (within 3 years) decreased among women aged 65 years and older without a hysterectomy, from 73.5 % in 2000 to 64.5 % in 2010 (MMWR 2013;61:1043-7). However, women aged 30-64 years who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous 3 years – from 74.4 % in 2000 to 68.7 % in 2010.

"Women not receiving recommended screening and follow-up are at increased risk for cervical cancer mortality," the researchers noted. "Underscreening among women with less education, no usual source of health care, and no health care coverage is well documented and a persistent cause of health disparities."

Both studies were funded by the CDC.

SAN DIEGO – Age-accelerated changes in certain aspects of cognition, including psychomotor speed and verbal memory, appear to occur in aging persons with childhood-onset epilepsy, compared with healthy controls, according to preliminary results from an ongoing study.

"One thing that remains unclear is how people with childhood-onset epilepsies age over the decades in terms of brain structure and function," Bruce Hermann, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"There has been much interest in the issues of cognitive and brain aging in the general population, and, of course, in disorders such as dementia and Alzheimer’s disease, but unknown is how individuals with childhood-onset epilepsy may age over the decades. There are very few population-based cohorts available to address that question."

Dr. Hermann, who directs of the Charles Matthews Neuropsychology Lab in the department of neurology at the University of Wisconsin, Madison, is examining this question in collaboration with Dr. Matti Sillanpää, professor emeritus of child neurology at the University of Turku, Finland.

Together they are studying Dr. Sillanpää’s well known population-based cohort of children with epilepsy and controls. Followed since their youth over the decades, the research participants now range in age from 45 to 62 years. These subjects are returning for a comprehensive battery of cognitive tests, neuroimaging, EEG, and clinical interview to evaluate their aging processes. Cognitive tests administered including the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), the Wechsler Adult Intelligence Scale–III (WAIS-III), the Boston Naming Test, the Controlled Oral Word Association Test, the Clock Drawing Test, the Wechsler Memory Scale–Revised (WMS-R), the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Beck Depression Inventory. The follow-up visits also include structural MRI and PET amyloid and glucose imaging.

The mean age of patients examined to date is 57 years, and they are compared with a group of similarly aged matched controls. Dr. Hermann reported that in the first group of participants to be examined, 26 epilepsy patients performed significantly worse than did 31 controls on measures of psychomotor speed based on the WAIS-III (P less than .05) and in delayed verbal memory based on the WMS-R (P = .031).

"Secondary analyses revealed that patients with persisting abnormal EEG and either active epilepsy/seizures into adulthood had more adversely affected cognition compared to those whose epilepsy completely remitted," the researchers wrote in their poster.

Results from the PET imaging studies are pending, Dr. Hermann said, but preliminary results from the MRI studies demonstrated that there were no differences in cortical thickness between the epilepsy and control groups after correction for multiple comparisons and adjustment for age and gender. However, compared with the control group, the epilepsy group demonstrated a significant increase in the white matter hypointensity index (P less than .05) and a trend toward larger left and right lateral ventricles (P = .10). "What’s surprising is that their MRI results look as good as they do, compared with controls," Dr. Hermann said. "We thought we’d see more pathology and age-accelerated changes."

Dr. Sillanpää’s entire cohort is in the process of returning for study and the results should shed new light on the issues of cognitive and brain aging in childhood epilepsy.

The study was funded by the Finnish Government Research Fund and Citizens United for Research in Epilepsy (CURE). Dr. Hermann said that he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Age-accelerated changes in certain aspects of cognition, including psychomotor speed and verbal memory, appear to occur in aging persons with childhood-onset epilepsy, compared with healthy controls, according to preliminary results from an ongoing study.

"One thing that remains unclear is how people with childhood-onset epilepsies age over the decades in terms of brain structure and function," Bruce Hermann, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"There has been much interest in the issues of cognitive and brain aging in the general population, and, of course, in disorders such as dementia and Alzheimer’s disease, but unknown is how individuals with childhood-onset epilepsy may age over the decades. There are very few population-based cohorts available to address that question."

Dr. Hermann, who directs of the Charles Matthews Neuropsychology Lab in the department of neurology at the University of Wisconsin, Madison, is examining this question in collaboration with Dr. Matti Sillanpää, professor emeritus of child neurology at the University of Turku, Finland.

Together they are studying Dr. Sillanpää’s well known population-based cohort of children with epilepsy and controls. Followed since their youth over the decades, the research participants now range in age from 45 to 62 years. These subjects are returning for a comprehensive battery of cognitive tests, neuroimaging, EEG, and clinical interview to evaluate their aging processes. Cognitive tests administered including the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), the Wechsler Adult Intelligence Scale–III (WAIS-III), the Boston Naming Test, the Controlled Oral Word Association Test, the Clock Drawing Test, the Wechsler Memory Scale–Revised (WMS-R), the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Beck Depression Inventory. The follow-up visits also include structural MRI and PET amyloid and glucose imaging.

The mean age of patients examined to date is 57 years, and they are compared with a group of similarly aged matched controls. Dr. Hermann reported that in the first group of participants to be examined, 26 epilepsy patients performed significantly worse than did 31 controls on measures of psychomotor speed based on the WAIS-III (P less than .05) and in delayed verbal memory based on the WMS-R (P = .031).

"Secondary analyses revealed that patients with persisting abnormal EEG and either active epilepsy/seizures into adulthood had more adversely affected cognition compared to those whose epilepsy completely remitted," the researchers wrote in their poster.

Results from the PET imaging studies are pending, Dr. Hermann said, but preliminary results from the MRI studies demonstrated that there were no differences in cortical thickness between the epilepsy and control groups after correction for multiple comparisons and adjustment for age and gender. However, compared with the control group, the epilepsy group demonstrated a significant increase in the white matter hypointensity index (P less than .05) and a trend toward larger left and right lateral ventricles (P = .10). "What’s surprising is that their MRI results look as good as they do, compared with controls," Dr. Hermann said. "We thought we’d see more pathology and age-accelerated changes."

Dr. Sillanpää’s entire cohort is in the process of returning for study and the results should shed new light on the issues of cognitive and brain aging in childhood epilepsy.

The study was funded by the Finnish Government Research Fund and Citizens United for Research in Epilepsy (CURE). Dr. Hermann said that he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO – Age-accelerated changes in certain aspects of cognition, including psychomotor speed and verbal memory, appear to occur in aging persons with childhood-onset epilepsy, compared with healthy controls, according to preliminary results from an ongoing study.

"One thing that remains unclear is how people with childhood-onset epilepsies age over the decades in terms of brain structure and function," Bruce Hermann, Ph.D., said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"There has been much interest in the issues of cognitive and brain aging in the general population, and, of course, in disorders such as dementia and Alzheimer’s disease, but unknown is how individuals with childhood-onset epilepsy may age over the decades. There are very few population-based cohorts available to address that question."

Dr. Hermann, who directs of the Charles Matthews Neuropsychology Lab in the department of neurology at the University of Wisconsin, Madison, is examining this question in collaboration with Dr. Matti Sillanpää, professor emeritus of child neurology at the University of Turku, Finland.

Together they are studying Dr. Sillanpää’s well known population-based cohort of children with epilepsy and controls. Followed since their youth over the decades, the research participants now range in age from 45 to 62 years. These subjects are returning for a comprehensive battery of cognitive tests, neuroimaging, EEG, and clinical interview to evaluate their aging processes. Cognitive tests administered including the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), the Wechsler Adult Intelligence Scale–III (WAIS-III), the Boston Naming Test, the Controlled Oral Word Association Test, the Clock Drawing Test, the Wechsler Memory Scale–Revised (WMS-R), the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Beck Depression Inventory. The follow-up visits also include structural MRI and PET amyloid and glucose imaging.

The mean age of patients examined to date is 57 years, and they are compared with a group of similarly aged matched controls. Dr. Hermann reported that in the first group of participants to be examined, 26 epilepsy patients performed significantly worse than did 31 controls on measures of psychomotor speed based on the WAIS-III (P less than .05) and in delayed verbal memory based on the WMS-R (P = .031).

"Secondary analyses revealed that patients with persisting abnormal EEG and either active epilepsy/seizures into adulthood had more adversely affected cognition compared to those whose epilepsy completely remitted," the researchers wrote in their poster.

Results from the PET imaging studies are pending, Dr. Hermann said, but preliminary results from the MRI studies demonstrated that there were no differences in cortical thickness between the epilepsy and control groups after correction for multiple comparisons and adjustment for age and gender. However, compared with the control group, the epilepsy group demonstrated a significant increase in the white matter hypointensity index (P less than .05) and a trend toward larger left and right lateral ventricles (P = .10). "What’s surprising is that their MRI results look as good as they do, compared with controls," Dr. Hermann said. "We thought we’d see more pathology and age-accelerated changes."

Dr. Sillanpää’s entire cohort is in the process of returning for study and the results should shed new light on the issues of cognitive and brain aging in childhood epilepsy.

The study was funded by the Finnish Government Research Fund and Citizens United for Research in Epilepsy (CURE). Dr. Hermann said that he had no relevant financial conflicts to disclose.

d.brunk@elsevier.com

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.