title: Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel.
abstract: To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process.
  
  
  
  An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention.
  
  
  
  The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus.
  
  
  
  We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies for genetic testing and Dravet syndrome-specific therapies, and (3) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies.
authors.affiliation: Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address: wirrell.elaine@mayo.edu.
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Wirrell
authors.affiliation: Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
authors.forename: Linda
authors.initials: L
authors.lastname: Laux
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Donner
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.affiliation: Department of Pediatrics, University of Colorado, Aurora, Colorado; Department of Neurology, University of Colorado, Aurora, Colorado.
authors.forename: Kelly
authors.initials: K
authors.lastname: Knupp
authors.affiliation: Dravet Syndrome Foundation.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Meskis
authors.affiliation: Comprehensive Epilepsy Program, Nicklaus Children's Hospital, Miami, Florida.
authors.forename: Ian
authors.initials: I
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, University of California, San Francisco, California; Department of Neurology, University of California, San Francisco, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sullivan
authors.affiliation: Intractable Childhood Epilepsy Alliance.
authors.forename: Michelle
authors.initials: M
authors.lastname: Welborn
authors.affiliation: Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
authors.forename: Anne T
authors.initials: AT
authors.lastname: Berg
mesh_terms: D003697:Delphi Technique; D019468:Disease Management; D004831:Epilepsies, Myoclonic / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans
keywords: Dravet syndrome; diagnosis; genetic testing; guidelines; questionnaire