title: National trends in pediatric use of anticonvulsants.
abstract: OBJECTIVE
  This research study aimed to assess national trends in pediatric use of anticonvulsants for seizures and psychiatric disorders.
  
  
  METHODS
  In a cross-sectional design, data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed. Outpatient visit information for youths (ages 0-17 years) was grouped by year for 1996-1997, 2000-2001, 2004-2005, and 2008-2009. Six of the most common anticonvulsant drugs used for psychiatric conditions were examined. Psychiatric diagnoses and seizure or convulsion diagnoses were identified with ICD-9-CM codes. The primary outcome measure was percentage prevalence of visits for anticonvulsants that included a psychiatric diagnosis as a proportion of total youth visits for an anticonvulsant. Total, diagnosis-stratified, and drug-specific visits, as well as visits for concomitant anticonvulsants and psychotropics, were analyzed.
  
  
  RESULTS
  As a proportion of total youth visits for anticonvulsants, visits with a psychiatric diagnosis increased 1.7 fold (p<.001), whereas the proportion of seizure-related visits did not change significantly. Regardless of diagnosis, anticonvulsant use significantly increased, from .33% to .68% of total youth visits in the 14-year period. There were significant increases in anticonvulsant use to treat pediatric bipolar disorder and disruptive behavior disorders. Visits noting divalproex decreased while visits noting lamotrigine increased among visits involving a psychiatric diagnosis. The concomitant use of stimulants and anticonvulsants significantly increased in visits noting a psychiatric diagnosis.
  
  
  CONCLUSIONS
  Whereas anticonvulsant use for seizure disorders across the 14-year period was stable, the use of these drugs for psychiatric conditions rose to a dominant position. The growth of concomitant and off-label use to treat behavioral disorders raises questions about effectiveness and safety in community populations of youths.
authors.affiliation: Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch St., Baltimore, MD 21201, USA.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Tran
authors.forename: Julie M
authors.initials: JM
authors.lastname: Zito
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Safer
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Hundley
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D008484:Medicaid / Q000639:trends; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D056687:Off-Label Use / Q000706:statistics & numerical data; D012640:Seizures / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents