Best Seizure Medicines For Children Are Used Less Often

What was studied

This study looked at which first antiseizure medicine was prescribed to children with epilepsy in the United States from 2015 to 2024. It used the Epic Cosmos electronic health record database, a national repository covering over 300 million patients.

The researchers included children ages 4 to 18 who were prescribed their first seizure medicine and had a single ASM prescription, excluding children with absence epilepsy. In total, 146,395 children were studied. The researchers compared prescribing over time and across sex, race and ethnicity, and social vulnerability.

What they found

Levetiracetam was the most common first medicine overall, used in 58% of children, and its use increased from 47% in 2015 to 66% in 2024. Over the same period, lamotrigine use fell from 10% to 5.5%, and valproate use fell from 12% to 7.5%.

Females were prescribed valproate less often than males (5% vs 12%). Lamotrigine was prescribed less often in children with higher social vulnerability and less often in Black, Asian, Hispanic/Latino, and male patients than in comparison groups.

The authors note that lamotrigine use declined despite trial evidence supporting it for some children, while levetiracetam use continued to rise.

Limits of the evidence

This was an observational study using electronic health records, so it shows prescribing patterns but cannot prove why clinicians chose one medicine over another. It also cannot determine from the abstract whether any one child received the wrong treatment.

The abstract does not give details about seizure type beyond excluding absence epilepsy, severity, side effects, other health conditions, or why a medicine may have been preferred. The study only included children with a single ASM prescription, so the results may not apply to children who needed more complex treatment. Because the data come from one large record repository, the findings may not perfectly represent all U.S. children.

For families and caregivers

This study suggests that first-treatment choices for childhood epilepsy in the U.S. have shifted toward levetiracetam, while use of lamotrigine has decreased, even though clinical trials have supported lamotrigine for some children. It also raises concern that treatment patterns differ by race, ethnicity, and social factors.

For families, this may matter because the first seizure medicine can affect seizure control and side effects. The study does not show what is best for every child, but it supports asking whether the chosen medicine fits the child’s seizure type, age, and other health needs, and whether there are evidence-based alternatives.

What to watch next

Stronger evidence would include studies that link prescribing choices to seizure control, side effects, and long-term outcomes in different groups of children.

Terms in this summary

antiseizure medication

A medicine used to prevent or reduce seizures.

monotherapy

Treatment with just one medicine instead of a combination.

retrospective cross-sectional cohort study

A study that looks back at existing records to describe patterns in a group of people.

electronic health record

A digital medical chart used by doctors and hospitals.

valproate

An antiseizure medicine that can be effective for some seizure types and has important safety concerns, especially related to pregnancy.

lamotrigine

An antiseizure medicine used for focal and some generalized epilepsies.

levetiracetam

A commonly used antiseizure medicine.

social vulnerability index

A measure of how much a community may be affected by social and economic challenges.