Real-world comparison of first-line antiseizure monotherapy and the role of age at treatment initiation in newly diagnosed childhood epilepsy: A cohort study from a tertiary center

Sep 30, 2026

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Objective: Evaluate real-world effectiveness and tolerability of first-line antiseizure medication (ASM) monotherapy in children with newly diagnosed epilepsy, comparing outcomes across developmental age groups and ASM types, and determining clinical risk factors for treatment failure. Methods: A retrospective cohort analyzed 10 years of electronic medical records from Shenzhen Children’s Hospital. Children ≤18 years initiating monotherapy with oxcarbazepine, valproate, levetiracetam, topiramate, or lamotrigine were followed for treatment success and ILAE-defined outcomes. Results: 7060 patients showed 47.9% treatment success and 48.3% meeting ILAE criteria, with key failure predictors including seizure characteristics, delayed initiation, and neurodevelopmental comorbidities.

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Abstract

Objective and Methods

Results

Introduction

DOI: 10.1111/epi.18607 RESEAR CH ARTICLE Real-world comparison of first-line antiseizure monotherapy and the role ofage at treatment initiation in newly diagnosed childhood epilepsy: A cohort study from a tertiary center Ningshan Li1,2 | Huiting Zhang3 | Chaoran Yang1 | Xiaoying Qiao3 | Dezhi Cao3 | Lina Men3 | Guangjun Yu1,4 | Jianxiang Liao3 1Second Affiliated Hospital, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China 2Department of Surgery, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA 3Pediatric Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China 4School of Medicine, Chinese University of Hong Kong, Shenzhen, Shenzhen, China Correspondence Guangjun Yu, School of Medicine, Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Road, Longgang District, Shenzhen, Guangdong 518172, China. [Email:](Email: guangjunyu@cuhk.edu.cn)[ guangjunyu@cuhk.edu.cn](Email: guangjunyu@cuhk.edu.cn) Jianxiang Liao, Pediatric Epilepsy Center, Shenzhen Children's Hospital, No. 7019 Yitian Road, Futian District, Shenzhen, Guangdong 518038, China. Email: [epilepsycenter@vip.163.com](epilepsycenter@vip.163.com) Funding information Shenzhen Science and Technology Program; Shenzhen Fund, Grant/Award Number: JCYJ20200109150818777; Shenzhen Fund for Guangdong Provincial Highlevel Clinical Key Specialties, Grant/Award Number: SZGSP012; Shenzhen Key Medical Discipline Abstract Objective: This study was undertaken to evaluate the real-world effectiveness and tolerability of first-line antiseizure medication (ASM) monotherapy in children with newly diagnosed epilepsy, focusing on comparative outcomes across developmental age groups and ASM types, and identifying clinical risk factors of treatment failure. Methods: This retrospective cohort study analyzed 10 years of electronic medical records from Shenzhen Children's Hospital. Children aged ≤18years who initiated monotherapy with one of five ASMs (oxcarbazepine, valproate, levetiracetam, topiramate, or lamotrigine) were included. The primary outcome was treatment success, defined as sustained seizure and side effect freedom at the defined analytic endpoint. Outcomes based on the 2010 International League Against Epilepsy (ILAE) definition were also evaluated. Nineteen clinical variables across six domains were analyzed. Multivariable Cox regression and stabilized inverse probability of treatment weighting were used to adjust for confounding. Results: Among 7060 eligible patients with a median follow-up of 14.0 months, 47.9% achieved treatment success, and 48. 3% met ILAE criteria. The median seizure- and side effect-free survival was 24.8 months (95% confidence interval [CI] = 23.3–26.5 months) . Oxcarbazepine (32.3%), valproate (31.7%), and levetiracetam (22.5%) were the most commonly prescribed ASMs. Treatment success did not differ significantly across ASM types or age groups. Epileptic spasms (hazard ratio [HR] = 2.86, 95% CI = 1.98–4.09), generalized seizures (HR = 1.78, 95% CI = 1.49–2.13), seizures before reaching maintenance dose (HR = 1.52, 95% CI = 1.37–1.70), delayed treatment initiation (HR ~ 1.30), and neurodevelopmental delay (HR = 1.42, 95% CI = 1.26–1.60) were significant risk factors of treatment failure. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. Construction Fund, Grant/Award Number: SZXK033; Sanming Project of Medicine in Shenzhen, Grant/Award Number: SZSM202311028; Guangdong High level Hospital Construction Fund; Shenzhen, Grant/Award Number: KCXFZ20211020163549011 Significance: First-lin

FAQs

What was the study’s primary goal regarding antiseizure therapy in children?

To assess real-world effectiveness and tolerability of first-line ASM monotherapy in newly diagnosed children, comparing developmental age groups and ASM types, and identifying risk factors for treatment failure.

How was treatment success defined in this cohort study?

Treatment success required sustained seizure control and freedom from side effects at the predefined analytic endpoint, with additional evaluation using the 2010 ILAE definition.

Which factors were associated with a higher risk of treatment failure?

Epileptic spasms, generalized seizures, seizures before reaching maintenance dose, delayed treatment initiation, and neurodevelopmental delay were significant risk factors.

Sep 30, 2026

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