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Abstract Since 2018, three new antiseizure medications (ASMs) received FDA approval for Dravet syndrome (DS) in the U.S: cannabidiol, stiripentol, and fenfluramine. Yet, the uptake of these ASMs in routine clinical practice is unknown. We use new ICD‐10 codes for DS (implemented in 2020) to estimate ASM receipt in patients with DS. We analyzed the TriNetX Network, a real‐time electronic health record‐based dataset linked to prescription data encompassing all 50 states of the U.S. After identifying patients with health care encounters for DS in 2021 and 2022 (via ICD‐10 codes), we examined ASM prescribing in the year following a DS claim: 2022 and 2023, respectively. We retrieved 387 and 451 patients receiving claims for DS in 2021 and 2022, respectively. Clobazam, diazepam, valproate, midazolam, clonazepam, levetiracetam, and cannabidiol were the most common ASMs used (29%–44%). Stiripentol and fenfluramine prescribing was limited (7%–16%); these two ASMs, considered second‐line therapies in DS, were prescribed less often than ASMs considered third‐line or beyond. Cannabidiol, stiripentol, and fenfluramine prescribing rates remained nearly identical in the 2021 and 2022 cohorts. Our data suggests that stiripentol, fenfluramine, and, to an extent, cannabidiol may be underused in a large, diverse, primarily U.S.‐based population of patients with DS. Plain Language Summary In an analysis of routinely‐collected health care claims in the U.S., we found that the uptake of new antiseizure medications for Dravet Syndrome (i.e., stiripentol, fenfluramine, and cannabidiol) has been limited since 2022. Even though stiripentol and fenfluramine are considered second‐line treatments for Dravet syndrome, we found they were prescribed less frequently than medicines considered third‐line or beyond. These findings raise concern for underutilization of new antiseizure medications for Dravet syndrome in the United States.

Background Among presenting conditions in pediatric acute care settings, conduct disorder (CD) is a potentially stigmatizing yet common diagnosis in the setting of behavioral dysregulation requiring psychiatric admission. Concerns exist about over‐diagnosis of CD in non‐Hispanic Black children relative to White peers and the potential for the CD diagnosis to obfuscate manifestations of co‐occurring psychiatric conditions. Methods We evaluated the number of manuscripts on CD diagnoses that report race and ethnicity and co‐occurring mental health characteristics (i.e., history of trauma, attention‐deficit hyperactivity disorder [ADHD], or substance use disorders [SUDs]) that are often undertreated in racially minoritized children. Using the keywords “conduct disorder” or “externalizing disorder,” we screened peer‐reviewed articles in PubMed published from January 2013 to November 2023. Results We screened 2791 manuscripts for potential inclusion, of which 136 were original research articles with data on children with CD diagnoses. Thirteen articles contained racial and ethnic data for people with CD diagnoses, with the majority illustrating that Black children were overrepresented among those with CD diagnoses. No studies provided details on how race and ethnicity were ascertained and few mentioned racism as a potential explanation for racial disparities in CD diagnoses. No studies contained data collected after 2016, with three studies using data collected as early as 2001–2002. Across all articles, data on co‐occurring trauma, ADHD, and SUDs were scarce. Conclusions The overwhelming majority of studies on CD diagnoses did not provide comprehensive data on race and ethnicity and co‐occurring psychiatric disorders in children receiving diagnoses of CD.

Background: Off-label prescribing of Epidiolex® (pharmaceutical cannabidiol) comes with both potential benefits and risks for patients. The aims of this study were to: (1) identify the percentage of people prescribed Epidiolex® who do not have diagnostic indications for Epidiolex® (Lennox Gastaut Syndrome [LGS], Dravet Syndrome [DS], and Tuberous Sclerosis Complex [TSC]) and (2) examine potential co-prescribing of medications that may interact with Epidiolex®. Method: Using TriNetX analytics, a web-based database of de-identified electronic health records spanning >110 million people in the United States, we analyzed 4214 people receiving Epidiolex® in 2022. We computed the number of people prescribed Epidiolex® who did not have diagnoses for LGS, DS, or TSC. We evaluated the prevalence of co-occurring prescriptions that are known to interact with cannabidiol following each individual’s first Epidiolex® prescription. Results: Among individuals receiving Epidiolex®, 40 % did not have FDA-approved diagnostic indications (LGS/DS/TSC) in the medical record. In the overall sample, co-occurring psychotropic prescribing was prevalent, including medications with known interactions with cannabidiol (Clobazam=47.2 %; Diazepam=47.4 %; Clonazepam=40.7 %). Among individuals without LGS/DS/TSC who received Epidiolex®, the most common diagnoses received following the index prescription were unspecified epileptic syndromes (53.8 %), sleep disorders (25.7 %), anxiety disorders (25.9 %), mood disorders (18.6 %) and autism spectrum disorders (10.8 %). Conclusion: Off-label prescribing and co-prescription of medications with known interactions with cannabidiol is prevalent. Further research is needed to elucidate longitudinal outcomes associated with off-label Epidiolex® prescribing.