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Research ArticleOriginal Article
Open Access

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 and Mohammed Jan
Neurosciences Journal July 2023, 28 (3) 170-176; DOI: https://doi.org/10.17712/nsj.2023.3.20230008
Mudhawi Alhiniah
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Asma Alshahrani
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Renad Rajab
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Rakan Alelyani
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Atheer Badawi
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Abrar Abbar
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Mashael Abdulsbhan
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Amir Alrajhi
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Osama Muthaffar
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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  • For correspondence: [email protected]
Mohammed Jan
From the Faculty of Medicine (Alhiniah, Alshahrani, Rajab, Alelyani, Badawi, Alrajhi), Departments of Pediatrics (Abbar, Abdulsbhan, Muthaffar, Jan), Faculty of Medicine, King Abdulaziz University, Jeddah, and from Departments of Pediatrics (Abbar), East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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  • Figure 1
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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.

Tables

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    Table 1

    - Frequencies of sociodemographic data of pediatric neurologists.

    Sociodemographic datan(%)
    Gender
    Male43(60.6)
    Female28(39.4)
    Total71(100)
    Age
    < 3512(16.9)
    35-4523(32.4)
    46–5518(25.4)
    >5518(25.4)
    Total71(100)
    Years of practice (After board)
    <517(23.9)
    5–1017(23.9)
    11–2017(23.9)
    >2020(28.2)
    Total72(100)
    Post-graduate training
    Saudi Arabia25(35.2)
    North America34(47.9)
    Europe5(7.0)
    Other7(9.9)
    Total71(100)
    Current practice
    Saudi Arabia64(90.1)
    Outside Saudi Arabia7(9.9)
    Total71(100)
    City of practice
    Riyadh27(38)
    Jeddah14(19.7)
    Other (18 cities)30(42.3)
    Total71(100)
    Type of primary practice
    University13(18.3)
    Ministry of Health34(47.9)
    Military/National Guard11(15.5)
    King Faisal Specialist Hospital9(12.7)
    Private4(5.6)
    Total71(100)
    How often do you see and follow children with epilepsy?
    Sometimes4(5.6)
    Always67(94.4)
    Total71(100)
    How often do you see children with drop attacks?
    Sometimes48(67.6)
    Always23(32.4)
    Total71(100)
    • View popup
    Table 2

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

    First lineSecond lineThird 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 acid54 (76.1)Clobazam25 (35.2)Clobazam21 (29.6)
     Clobazam6 (8.5)Levetiracetam13 (18.3)Rufinamide9 (12.7)
     Levetiracetam5 (7)Valproic acid12 (16.9)Clonazepam8 (11.3)
     Clonazepam2 (2.8)Topiramate8 (11.3)Levetiracetam8 (11.3)
     Topiramate1 (1.4)Clonazepam5 (7)Topiramate6 (8.5)
     Other3 (4.2)Other8 (11.3)Other19 (26.6)
    If a steroid was one of your three treatment options, which of the following steroids would you use?
     Not applicable37 (52.1)    
     Oral prednisone25 (35.2)    
     IV Methylprednisolone6 (8.51)    
     ACTH3 (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 acid55 (77.5)Clobazam26 (36.6)Clobazam13 (18.3)
     Levetiracetam8 (11.3)Levetiracetam14 (19.7)Topiramate10 (14.1)
     Clobazam4 (5.6)Topiramate11 (15.5)Rufinamide10 (14.1)
     Clonazepam1 (1.4)Valproic acid10 (14.1)Clonazepam7 (9.9)
     Topiramate1 (1.4)Lamotrgine5 (7.0)Levetiracetam7 (9.9)
     Other2 (2.8)Other5 (7.0)Other24 (33.7)
    If a steroid was one of your three treatment options, which of the following steroids would you use?
     Not applicable38 (53.5)    
     Oral prednisone22 (31)    
     IV Methylprednisolone8 (11.3)    
     ACTH3 (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.
     Levetiracetam31 (43.7)Clobazam25 (35.2)Topiramate17 (23.9)
     Valproic acid11 (15.5)Levetiracetam14 (19.7)Valproic acid12 (16.9)
     Clobazam11 (15.5)Topiramate11 (15.5)Levetiracetam10 (14.1)
     Clonazepam6 (8.5)Valproic acid8 (11.3)Steroid8 (11.3)
     Topiramate5 (7)Clonazepam8 (11.3)Clobazam7 (9.9)
     Other7 (9.8)Other5 (7)Other17 (23.9)
    If a steroid was one of your three treatment options, which of the following steroids would you use?
     Not applicable37 (52.1)    
     Oral prednisone21 (29.6)    
     IV methylprednisolone7 (9.9)    
     ACTH6 8.5    
    • ACTH – adrenotropic hormone

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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
Neurosciences Journal Jul 2023, 28 (3) 170-176; DOI: 10.17712/nsj.2023.3.20230008

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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
Neurosciences Journal Jul 2023, 28 (3) 170-176; DOI: 10.17712/nsj.2023.3.20230008
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