Analysis of anticonvulsants in children with symptomatic epilepsy

Epilepsy has been and remains an extremely important medical and socially significant problem of pediatric neurology. According to some authors, the average annual incidence of epilepsy in the economically developed countries of the world is 17.3 cases per 100 thousand people per year. The prevalence of epilepsy in the world is 5-10 cases per 1000 population. In the CIS countries, including Ukraine, this indicator is in the range of 0.96-3.4 per 1000 population.

Epilepsy has a comprehensive negative impact on children suffering from this disease, causing significant limitations that do not allow them to fully realize themselves in various spheres of life. Therefore, one of the most important problems is the therapy of epileptic disorders in order to achieve remission and improve the quality of life of patients.

The aim of the study was to determine the effectiveness of antiepileptic therapy in children with symptomatic epilepsy.

We observed 120 children aged 1 to 17 years with symptomatic epilepsy. All patients underwent a clinical study; anamnesis, neurological examination; EEG, long-term EEG monitoring in wakefulness, EEG sleep, magnetic resonance imaging (MRI) or (and) neurosonography, consultations of related specialists. In order to verify the diagnosis, the following medical documentation was used: individual outpatient card, hospital discharge, supplementary research methods.

Patients included in the study received carbamazepine, valproate, lamotrigine, topiramate, phenobarbital and benzodiazepines. At the beginning of the examination, 75 of 120 patients received monotherapy and 45 - polytherapy, in which two drugs were taken by 43 patients and three anticonvulsants - 2 patients.

The selection of anticonvulsants in our study was conducted in accordance with the recommendations of the International Antiepileptic League (ILAE 2001-2004), taking into account clinical manifestations and EEG data from the perspective of "evidence-based medicine".

Etiology of epilepsy in 45 people (37.5%) was associated with perinatal factors, in 24 patients (20%) - with congenital anomalies of brain development, in 14 patients (11.7%) - with traumatic brain injury, in 5 of patients (4.1%) with tuberous sclerosis, in 31 patients (26.7%) with infectious diseases of the nervous system. Patients among the etiological factors prevailed perinatal CNS lesions.

When analyzing anamnestic data in patients with symptomatic focal forms of epilepsy, it was found that the disease debuted in infancy in 26 patients (22%), in early childhood in 35 patients (29%), in late childhood in 47 patients (39 , 5%), in pubertal age - in 8 patients (6.5%), in adolescence - in 4 patients (3%). In most patients epilepsy often debuted in late childhood.

Phenobarbital was given to children aged 1 to 10 years. Among the patients taking carbamazepine, valproic acid preparations and topiromate, the most numerous were subgroups of patients aged 7 to 10 years and early adolescence (11 to 14 years). The most numerous was a subgroup of adolescent patients (15 to 17 years) in a sample of patients receiving lamotrigine.

In the course of the study, the age-related efficacy of antiepileptic drugs in the study group of patients was analyzed. The percentage was calculated from the total number of patients taking a certain drug. In assessing the effectiveness of anticonvulsant therapy, the following indicators were evaluated: remission, reduction of seizures by more than 50%, reduction in seizures by less than 50%, increased frequency of attacks, and lack of effect. A positive result was a remission + reduction of seizures by more than 50%, negative - inefficiency of therapy (increased frequency of attacks + no effect).

When taking medications:

• barbiturates in 1 patient aged 1 to 3 years, remission was achieved, the effect of barbiturate therapy was absent in 2 preschool and early school-age patients;
• benzodiazepines in 2 (28.8%) patients aged 4 to 10 years, clinical remission of epilepsy was achieved, in 1 (14.3%) patients of primary school age, seizures became more frequent, and in 4 (57.1%) patients the effect of therapy with benzodiazepines was absent. Clonazepam was equally ineffective in its use in all age groups;
• carbamazepine in 22 (44%) patients, complete clinical remission of epilepsy was achieved, in 2 (4%) patients seizures became more frequent, and in 26 (52%) patients the effect of carbamazepine therapy was absent. In all cases of frequent seizures, carbamazepine was gradually withdrawn;
• valproic acid in 23 (50%) patients, clinical remission was achieved, in 3 (6.5%) patients the seizures became more frequent, and in 20 (43.5%) patients there was a resistant course. Valproates were less effective when used in groups of children from 7 to 10 years and from 11 to 14 years - 6 (13%) patients, 4 to 6 years and 15 to 17 years - 5 (10.9%) patients . The greatest efficacy of valproate was observed in the group from 1 year to 3 years - in 5 out of 6 patients included in this group, remission was achieved; lamotrigine had a significant positive effect - 12 (85.7%) patients achieved complete clinical remission of epilepsy, in 25 (14.3%) patients there was no effect of lamotrigine therapy. Lamotrigine was ineffective in its use in the group of children aged 15 to 17 years - in 2 (14.3%) patients;
• (in 70% of patients) complete clinical remission of epilepsy was achieved, in 1 (2.1%) patients the attacks became more frequent, 13 (27.7%) patients remained resistant to therapy. In the group of children from 1 to 3 years, 4 (8.5%) patients achieved remission, 1 patient had a resistant course. In the pre-school age group, remission was achieved in 7 (14.9%) patients, in 3 (6.9%) patients the number of seizures decreased by less than 50%. In the group of children aged 7 to 10 years, remission was achieved in 7 (14.9%) patients, 4 (8.5%) patients were resistant to therapy. In the group of children from 11 to 14 years, remission was achieved in 9 (19.1%) patients, in 2 (4.3%) patients it was not possible to achieve complete relief of seizures. In adolescence, 6 (12.8%) patients experienced an efficacy of topiromate, and 4 (8,5%) patients had a resistant course. Thus, the topiromate was equally effective in its use in all age groups.

In carrying out the correlation analysis, it was found that carbamazepines in the age group of 4-6 years with temporal epilepsy, TBI as the etiological factor, debut in late childhood had the greatest effect; valproates - in the age groups 1-3 years and 7-10 years with occipital and parietal epilepsy, congenital developmental anomalies and perinatal lesions as etiologic factors, debut in early childhood; lamotrigine - in the age group 11-14 years with frontal epilepsy, neuroinfections as an etiologic factor, debut at pre and pubertal age; topiramate - in all age groups with temporal epilepsy, congenital developmental anomalies, perinatal lesions and tuberous sclerosis as etiologic factors, debut in infancy and late childhood.

Thus, during the analysis of antiepileptic therapy, it was found that most often the patients took carbamazepines, valproate and topiromate. The maximum positive effect (remission and reduction of seizures more than 50%) from antiepileptic therapy was observed with carbamazepine in the age group 4-6 years, with valproate intake in the 1-3 year group, lamotrigine in the 11-14 year old group, a topiromate - in the group 7-10 and 15-17 years.

V. V. Salnikova, Assoc. O. Yu. Suhonosova, S. N. Korenev. Analysis of anticonvulsants in children suffering from symptomatic epilepsy // International Medical Journal No. 4 2012

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