Treatment of drop attacks: Anti-seizure drug choices of pediatric neurologists in Saudi Arabia

Mudhawi Alhiniah; Asma Alshahrani; Renad Rajab; Rakan Alelyani; Atheer Badawi; Abrar Abbar; Mashael Abdulsbhan; Amir Alrajhi; Osama Muthaffar; Mohammed Jan

doi:10.17712/nsj.2023.3.20230008

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Figure 1
- Significant correlations of first-line treatment (levetiracetam) in children with new onset epileptic drop attacks and normal initial MRI and EEG.

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Table 1

- Frequencies of sociodemographic data of pediatric neurologists.

Sociodemographic data	n	(%)
Gender
Male	43	(60.6)
Female	28	(39.4)
Total	71	(100)
Age
< 35	12	(16.9)
35-45	23	(32.4)
46–55	18	(25.4)
>55	18	(25.4)
Total	71	(100)
Years of practice (After board)
<5	17	(23.9)
5–10	17	(23.9)
11–20	17	(23.9)
>20	20	(28.2)
Total	72	(100)
Post-graduate training
Saudi Arabia	25	(35.2)
North America	34	(47.9)
Europe	5	(7.0)
Other	7	(9.9)
Total	71	(100)
Current practice
Saudi Arabia	64	(90.1)
Outside Saudi Arabia	7	(9.9)
Total	71	(100)
City of practice
Riyadh	27	(38)
Jeddah	14	(19.7)
Other (18 cities)	30	(42.3)
Total	71	(100)
Type of primary practice
University	13	(18.3)
Ministry of Health	34	(47.9)
Military/National Guard	11	(15.5)
King Faisal Specialist Hospital	9	(12.7)
Private	4	(5.6)
Total	71	(100)
How often do you see and follow children with epilepsy?
Sometimes	4	(5.6)
Always	67	(94.4)
Total	71	(100)
How often do you see children with drop attacks?
Sometimes	48	(67.6)
Always	23	(32.4)
Total	71	(100)

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Table 2

- First-, second-, and third-line antiepileptic drug choices in the three different cases.

First line			Second line		Third line
n (%)
Case scenario 1
A 5-year-old boy with spastic quadriplegic cerebral palsy post-HIE with mixed epilepsy, including frequent drop attacks.
	Valproic acid	54 (76.1)	Clobazam	25 (35.2)	Clobazam	21 (29.6)
	Clobazam	6 (8.5)	Levetiracetam	13 (18.3)	Rufinamide	9 (12.7)
	Levetiracetam	5 (7)	Valproic acid	12 (16.9)	Clonazepam	8 (11.3)
	Clonazepam	2 (2.8)	Topiramate	8 (11.3)	Levetiracetam	8 (11.3)
	Topiramate	1 (1.4)	Clonazepam	5 (7)	Topiramate	6 (8.5)
	Other	3 (4.2)	Other	8 (11.3)	Other	19 (26.6)
If a steroid was one of your three treatment options, which of the following steroids would you use?
	Not applicable	37 (52.1)
	Oral prednisone	25 (35.2)
	IV Methylprednisolone	6 (8.51)
	ACTH	3 (4.2)
Case scenario 2
A 4.5-year-old boy with idiopathic epilepsy who developed multiple seizures described as myoclonus and head drops associated with falls.
	Valproic acid	55 (77.5)	Clobazam	26 (36.6)	Clobazam	13 (18.3)
	Levetiracetam	8 (11.3)	Levetiracetam	14 (19.7)	Topiramate	10 (14.1)
	Clobazam	4 (5.6)	Topiramate	11 (15.5)	Rufinamide	10 (14.1)
	Clonazepam	1 (1.4)	Valproic acid	10 (14.1)	Clonazepam	7 (9.9)
	Topiramate	1 (1.4)	Lamotrgine	5 (7.0)	Levetiracetam	7 (9.9)
	Other	2 (2.8)	Other	5 (7.0)	Other	24 (33.7)
If a steroid was one of your three treatment options, which of the following steroids would you use?
	Not applicable	38 (53.5)
	Oral prednisone	22 (31)
	IV Methylprednisolone	8 (11.3)
	ACTH	3 (4.2)
Case scenario 3
A 15-month-old baby with new onset drop attacks. Initial MRI brain and interictal EEG were reported as normal.
	Levetiracetam	31 (43.7)	Clobazam	25 (35.2)	Topiramate	17 (23.9)
	Valproic acid	11 (15.5)	Levetiracetam	14 (19.7)	Valproic acid	12 (16.9)
	Clobazam	11 (15.5)	Topiramate	11 (15.5)	Levetiracetam	10 (14.1)
	Clonazepam	6 (8.5)	Valproic acid	8 (11.3)	Steroid	8 (11.3)
	Topiramate	5 (7)	Clonazepam	8 (11.3)	Clobazam	7 (9.9)
	Other	7 (9.8)	Other	5 (7)	Other	17 (23.9)
If a steroid was one of your three treatment options, which of the following steroids would you use?
	Not applicable	37 (52.1)
	Oral prednisone	21 (29.6)
	IV methylprednisolone	7 (9.9)
	ACTH	6 8.5