ORLANDO, Fla.—New data from Nationwide Children’s Hospital suggest comorbidities and social factors, not the type of or dose of an anti-seizure medication (ASM), are the primary drivers of side effect intensity in young patients with epilepsy, according to a presentation at the 2023 annual meeting of the American Epilepsy Society.

The researchers looked at the effects of sociodemographics, epilepsy features and comorbidities on the Pediatric Epilepsy Side Effects Questionnaire (PESQ) score. The PESQ, validated in 2012, measures 19 items across five major quality-of-life categories: cognitive, motor, behavioral, general neurologic and weight.

In this study, the researchers included 781 children whose seizures were well controlled with one ASM. Six different medications were reported: ethosuximide, lamotrigine, levetiracetam, oxcarbazepine, valproic acid/divalproex or zonisamide. The study also looked at variables such as epilepsy duration, insurance coverage, school accommodations like individualized learning plans (IEPs), race, sex and a diagnosis of anxiety or depression.

The researchers expected the PESQ score to vary by ASM, to increase with dose and to increase in patients who had attention-deficit/hyperactivity disorder (ADHD) or mood disorders. Surprisingly, none of the six medication types had a significant effect on PESQ score and neither did medication dose. However, having concurrent ADHD was a factor, they said.

“This probably means if [a child] tolerates a low dose they will probably do fine at a higher dose,” said abstract co-author Corinne McCabe, MD, a neurologist at Nationwide Children’s Hospital, in Columbus, Ohio.

ASM side effects were highest among patients with developmental delays and those who needed school accommodations, such as IEPs. Their total PESQ score was 1.47 times higher, and it was the only factor that significantly increased the odds ratio (OR) for a positive PESQ total score.

Side effects were also higher among patients with an ADHD diagnosis, and who were covered by public insurance. Their total PESQ score was 1.4 and 1.24 times higher, respectively.

These findings suggest that “comorbidity management and addressing sociodemographic needs may decrease reported ASM side effects,” the authors wrote.

 

Source: pharmacypracticenews.com, Donavyn Coffey

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