Audit study on justifying anti‑epileptic drug therapy in children with a first attack of unprovoked seizure

Background: According to the recent available guidelines and standards in the management of children with a first attack of unprovoked seizure, this study evaluates the practice of initiating anti‑epileptic drug (AED) therapy in children. Objective: The objective is to assess and improve the clinical practice, making treatment decisions more optimal and individualized. Patients and methods: Clinical standards for initiating AED therapy in children with a first attack of unprovoked seizure were derived from a compilation of recent guidelines and management standards of the American Academy of Neurology, the Child Neurology Society, the International League Against Epilepsy, as well as other researches. Children presented to the outpatient neurology clinic with a first unprovoked seizure were assessed against derived standards in a 1‑year audit through direct observation of clinical practice. Data were collected and transferred to computer software to be easily analyzed and reviewed, then expressed as tables, proportions, curves, and charts. Results: A total of 43 children were included. Overall, 40 (93%) cases were adherent to recent clinical guidelines and standards. Thirty‑two cases have started AED therapy appropriately, whereas three (7%) cases started AED inappropriately. Moreover, no case had an inappropriate decision of deferring AED therapy. Conclusions: Adherence to standards was optimal in most of the studied cases. The result of assessment was satisfactory. The aim should be directed to keep updated and spread knowledge of best available standards and guidelines to optimize management and improve child’s quality of life.