title: Treatment for continuous spikes and waves during sleep (CSWS): survey on treatment choices in North America.
abstract: OBJECTIVE
  Current literature does not allow an evidence-based approach to the treatment of continuous spikes and waves during sleep (CSWS). The aim of this study was to describe treatment choices made by clinicians caring for patients with CSWS in North America.
  
  
  METHODS
  A 24-question survey on treatment choices for CSWS was distributed to the members of the American Epilepsy Society (AES). The survey presented a clinical vignette of CSWS. The questions addressed treatment choices for that clinical scenario. Surveys were self-administered and collected using an online survey website (www.surveymonkey.com).
  
  
  RESULTS
  Two-hundred thirty-two surveys were completed. Prominent sleep-potentiated spiking was considered to warrant treatment by 81% of respondents. The proportion of patients in whom cognitive improvement occurs when sleep-potentiated spiking is effectively treated is in >75% of patients (according to 16% of respondents), in 25-75% of patients (according to 52% of respondents), in <25% of patients (according to 20% of respondents), and no or unclear cognitive changes (according to 12% of respondents). The preferred first choice to reduce sleep-potentiated epileptiform activity was high-dose benzodiazepines (47%), valproate (26%), and corticosteroids (15%). The preferred second-choice was valproate (26%), high-dose benzodiazepines (24%), and corticosteroids (23%). Among high-dose benzodiazepines, the preferred one was diazepam 1 mg/kg for one night followed by 0.5 mg/kg/day. The preferred dose of valproate was 30-49 mg/kg/day. Among corticosteroids the preferred choice was oral prednisone 2 mg/kg/day. The most commonly considered endpoints of treatment efficacy were (in decreasing order): response of epileptiform activity in electroencephalography (EEG), cognitive function, and seizure reduction. Results were consistent among respondents with different levels of training and clinical experience. There were differences in conceptualization and treatment approaches between pediatric and adult neurologists.
  
  
  CONCLUSIONS
  Most clinicians considered that prominent sleep-potentiated epileptiform activity should be treated. There was no agreement on best treatment, but potential candidates included high-dose benzodiazepines, valproate, levetiracetam, and corticosteroids.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A; Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: Iván
authors.initials: I
authors.lastname: Sánchez Fernández
authors.forename: Kevin
authors.initials: K
authors.lastname: Chapman
authors.forename: Jurriaan M
authors.initials: JM
authors.lastname: Peters
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Klehm
authors.forename: Michele C
authors.initials: MC
authors.lastname: Jackson
authors.forename: Anne T
authors.initials: AT
authors.lastname: Berg
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
mesh_terms: D000200:Action Potentials / Q000187:drug effects / Q000502:physiology*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage; D002648:Child; D002755:Choice Behavior; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D012894:Sleep Stages / Q000187:drug effects / Q000502:physiology*; D012955:Societies, Medical; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001569:Benzodiazepines
keywords: Antiepileptic drugs; Electroencephalogram; Epilepsy; Seizures; Sleep; Treatment