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G60 Starting antieplipeltic medications by non specialists: what are the hazards?
  1. NT El Tantawi,
  2. D Salama,
  3. B Hassanein,
  4. K Fathy
  1. Neurolohy, Mansoura University Children Hospital, Mansoura, Egypt

Abstract

Background Initial prescription of antiepileptic drugs (AEDs) for newly diagnosed epileptic children should be done by a specialist. However many new patients start their treatment by paediatrician witout expertice in epilepsy.

Aim To study the prescription of (AEDs) in children before they were referred to specialist (paediatric neurologist).

Methods This was a prospective study. Six hundred children referred for the first time to the epilepsy clinic in a tertiary university hospital were recruited. Detailed (AEDs) history was retrieved from the parents in their first visit regarding the number of seizure after which they start treatment, AEDs prescribed at the beginning of diagnosis and in the following 12 months, if the drug has changed and the reasons. Patients were classified as truly epileptic and non epileptic after being reviewed by 2 neurologists.

Results Truly epileptic patients represented 65% of the newly referred patients. Of those, 45% have started one or more of AEDs before referral. Thirty nine percent started after their first seizure. Monotherapy was initiated in 65% of epileptic patients. Soduim Valproate (65.1%) was the most frequently prescribed AED followed by Levetiracetam (41.0%) and topiramate (38.0%). The combination between Soduim valproate and Levetiracetam as a starting therapy was the most common. Twenty five percent of patients have changed the initial (AEDs) in the first 3 months of starting treatment. Worsening of seizures and non availability of the medication were the most common causes of changing (AEDs).

The non epileptic patients included diagnosis of: febrile seizures, breath holding attacks, pallid attacks and self stimulating. When offered to withdraw treatment after explanation of the condition by two neurologists, 28% refused to stop AEDs.

Conclusion Starting AEDs by non specialist paediatrician has the hazards of wrong diagnosis, inappropriate starting and changing of AEDs.

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