Seizure management and prescription patterns of anticonvulsants in Dravet syndrome: A multicenter cohort study from Germany and review of literature.

Abstract

OBJECTIVE:

The aim of this study was to describe the treatment pattern of patients with Dravet syndrome (DS) in Germany with routine antiepileptic drugs (AEDs) and emergency medication, and to review the literature of real-world evidence on medicine utilization of patients with DS in Europe.

METHODS:

Patient use of routine AEDs and emergency medications over 3-6 months was analyzed from a 2018 multicenter survey of 93 caregivers of patients with DS throughout Germany. Results were contextualized in a review of real-world evidence on medicine utilization of patients with DS in Europe.

RESULTS:

The variety of medications and the most frequent combinations routinely used by patients with DS (AEDs and others) are described. Patients use a large number of pharmaceutical treatments to manage seizures. The five most commonly used AEDs were sodium valproate (66% of the patients; mean daily dose: 660 mg; 24.5 mg per kg bodyweight), bromide (44%; 1462 mg; 51.2 mg per kg), clobazam (41%; 10.4 mg; 0.32 mg per kg), stiripentol (35%; 797 mg; 27.6 mg per kg), and topiramate (24%; 107 mg; 3.5 mg per kg). Ninety percent had reported using emergency medications in the last 3 months;, with the most common medications being Buccolam (40%, an oromucosal form of midazolam) and diazepam (20%, mostly rectal application). No discernable relationships between current medication and age or seizure frequency were observed.

SIGNIFICANCE:

This is the first comprehensive report of routine AEDs and emergency medication use in a large sample of patients with DS in Germany over a period of 3-6 months and shows that despite the most common AED combinations being in line with clinical guidelines/best practice, there is no discernable impact of best treatment on seizure frequency. We find a higher use of bromide in Germany compared with other real-world evidence in Europe.

• Authors: Susanne Schubert-Bast, Markus Wolff, Adelheid Wiemer-Kruel, Sarah von Spiczak, Regina Trollmann, Philipp S Reif, Clive Pritchard, Tilman Polster, Bernd A Neubauer, Thomas Mayer, Daniel Macdonald, Gerhard Kurlemann, Gerhard Kluger, Karl Martin Klein, Matthias Kieslich, Lara Kay, Malin Kalski, John Irwin, Arne Herting, Joe Carroll, Ulrich Bettendorf, Thomas Bast, Felix Rosenow, Adam Strzelczyk
• Journal: Epilepsy & behavior : E&B (Epilepsy Behav) Vol. 98 Issue Pt A Pg. 88-95 (09 2019) ISSN: 1525-5069 [Electronic] United States
• PMID: 31301455 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticonvulsants
• Topiramate
• Clobazam
• Valproic Acid

Topics

• Anticonvulsants (administration & dosage)
• Clobazam (administration & dosage)
• Cohort Studies
• Drug Prescriptions
• Drug Therapy, Combination
• Epilepsies, Myoclonic (drug therapy, epidemiology)
• Female
• Germany (epidemiology)
• Humans
• Male
• Seizures (drug therapy, epidemiology)
• Topiramate (administration & dosage)
• Valproic Acid (administration & dosage)