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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Advances in the Treatment of Epilepsy in Children


GOAL
To provide pediatric neurologists with up-to-date information on the diagnosis and management of epilepsy in children.

TARGET AUDIENCE
This activity is designed for pediatric neurologists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Describe the epidemiology of pediatric epilepsy and the current protocols for evaluating children with new-onset epilepsy.
  • Discuss the mechanisms of action, side-effect profiles, and practical use of available antiepileptic drugs (AEDs), and the data for use of these AEDs in the pediatric population.
  • Examine strategies for achieving and maintaining seizure control, with focus on monotherapy.
  • Discuss quality-of-life issues and long-term outcomes in children with epilepsy.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician’s Recognition award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity:  2 hours.

Release date: May 15, 2005. Expiration date: May 15, 2007.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Ortho-McNeil Pharmaceutical Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Directors and Participating Faculty reported the following:

PROGRAM DIRECTORS

Eileen P. G. Vining, MD
Professor, Department of Neurology 
Johns Hopkins University School of Medicine
Director, John M. Freeman Pediatric Epilepsy Center
Baltimore, Maryland 
Dr Vining reports receiving grants/research support from The Atkins Foundation; and receiving honoraria from unrestricted educational grants.

Eric H. Kossoff, MD
Assistant Professor
Department of Neurology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Kossoff reports serving on the speaker’s bureau for Ortho-McNeil Pharmaceutical Inc.

PARTICIPATING FACULTY

Barbara Olson, MD
Assistant Clinical Professor of Neurology and Pediatrics
Vanderbilt University
Nashville, Tennessee
Dr Olson reports serving as a consultant for Abbott Laboratories, GlaxoSmithKline, Novartis, Ortho-McNeil Pharmaceutical Inc, Pfizer Inc, Shire, UCB Pharma Inc, and Xcel Pharmaceuticals Inc; and receiving honoraria from Abbott Laboratories, GlaxoSmithKline, Novartis, Ortho-McNeil Pharmaceutical Inc, Pfizer Inc, Shire, UCB Pharma Inc, and Xcel Pharmaceuticals Inc.

Raman Sankar, MD, PhD
Professor of Neurology and Pediatrics
David Geffen School of Medicine at UCLA
Los Angeles, California
Dr Sankar reports receiving grants/research support from Cyberonics; and receiving honoraria from Eisai, GlaxoSmithKline, Ortho-McNeil Pharmaceutical Inc, UCB Pharma Inc, and Xcel Pharmaceuticals Inc.

James W. Wheless, MD
Professor of Neurology and Pediatrics
Director, Texas Comprehensive Epilepsy Program
University of Texas
Houston, Texas
Dr Wheless reports receiving grants/research support from Abbott Laboratories, Cyberonics, National Institutes of Health, Ortho-McNeil Pharmaceutical Inc, and UCB Pharma Inc; serving as a consultant for Abbott Laboratories, Cyberonics, Marinus Pharmaceuticals Inc, Ortho-McNeil Pharmaceutical Inc, Ovation Pharmaceuticals, and Xcel Pharmaceuticals Inc; and receiving honoraria from Abbott Laboratories, Cyberonics, GlaxoSmithKline, Novartis, Ortho-McNeil Pharmaceutical Inc, and UCB Pharma Inc.

Notice: The audience is advised that an article in this CME activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Sankar—All antiepileptic drugs used in children with epilepsy may involve some unlabeled use.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Advances in the Treatment of Epilepsy in Children
Eileen P. G. Vining, MD,* and Eric H. Kossoff, MD†

Epilepsy affects approximately 0.5% of all children, and may have profound implications on the development and quality of life of the children in whom it occurs. The treatment of epilepsy—new-onset and refractory—includes unique challenges for the pediatric population in which limited studies and guidance exist. Although the approval of several new antiepileptic drugs (AEDs) in the past decade adds to the complexity of therapeutic decision making in the care of pediatric patients, it also provides new opportunities for seizure control and the improvement of quality of life among children with epilepsy. In addition, the increased availability of nonpharmacologic therapies, such as the ketogenic diet, vagus nerve stimulation, and surgical resection, over the past decade have allowed for even more choices for the neurologist.

In this issue of Advanced Studies in Medicine, recent advances in the management of new-onset and refractory epilepsy in children are discussed. At the 33rd annual meeting of the Child Neurology Society in Ottawa, Ontario, Canada, on October 13-16, 2004, a considerable amount of new information was provided by leading experts in pediatric epilepsy to physicians to help guide their management of these complicated patients. Therefore, this monograph describes some of the latest information available on therapeutic advances in the management of pediatric epilepsy.

During an evening symposium, the issues of decision making in the treatment of epilepsy were discussed by Drs Raman Sankar, Barbara Olson, and James W. Wheless. Dr Sankar reviews the factors involved in choosing a particular anticonvulsant over another, and some of the comorbidities that can play an important role in this decision process. In addition, he shares his views regarding ideal treatments for specific pediatric epilepsy syndromes seen frequently in the office and hospital setting. Dr Olson offers her thoughts on the incidence and treatment of the refractory patient. Briefly touching on strategies for identifying and using rational medication choices, Dr Olson also discusses the ketogenic diet and epilepsy surgery in her article. Lastly, Dr Wheless describes his experiences with vagus nerve stimulation and identifies practical criteria for identifying appropriate candidates for this novel treatment modality.

In addition to this valuable symposium, there were more posters and presentations than in prior years on anticonvulsant therapy. Two posters discussed transitioning children from an older- to a newer-generation anticonvulsant; a presentation by Dr James W. Wheless described the transition from standard to extended-release carbamazepine in the treatment of children ages 2 to 17 years, and a poster by Dr Toufic Fakhoury discussed switching to lamotrigine from valproate in adolescents ages 16 to 20 years. Emerging clinical information on the use of newer AED agents for juvenile myoclonic epilepsy were presented, with posters by Dr Sanjeev Kothare discussing zonisamide and Dr Paul Levisohn studying topiramate. Dr Maria del Carmen Fons presented information on the use of topiramate in infants younger than 2 years. In a poster by Dr David Mandelbaum, information was presented on the effects of AED use on cognition and attention in children with newly diagnosed epilepsy. Lastly, in a very well-attended platform presentation, Dr Peter Camfield presented information from the Nova Scotia population regarding the incidence of the “nightmare” situation of subsequent intractable epilepsy among children who have previously achieved symptomatic remission.

*Professor, Department of Neurology, Johns Hopkins University School of Medicine, Director, John M. Freeman Pediatric Epilepsy Center, Baltimore, Maryland.
†Assistant Professor, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Eileen P. G. Vining, MD, Professor, Department of Neurology, Johns Hopkins University School of Medicine, Director, John M. Freeman Pediatric Epilepsy Center, Meyer 2-138 Neurology, 600 North Wolfe Street, Baltimore, MD 21287.
E-mail:
evining@jhmi.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.