Analysis of anticonvulsant medications 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 economically developed countries is 17.3 cases per 100 thousand population per year. The prevalence of epilepsy in the world is 5-10 cases per 1000 population. In the CIS countries, including Ukraine, this figure 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 suffering from symptomatic epilepsy. All patients underwent clinical examination; anamnesis, neurological examination; EEG, long-term EEG monitoring in wakefulness, sleep EEG, magnetic resonance imaging (MRI) and/or neurosonography, consultations with related specialists. The following medical documentation was used to verify the diagnosis: individual outpatient cards, hospital discharge summaries, data from additional research methods.

Patients included in the study received carbamazepine, valproate, lamotrigine, topiramate, phenobarbital and benzodiazepines. At the start of the study, 75 of the 120 patients were receiving monotherapy and 45 were receiving polytherapy, in which 43 patients were taking two drugs and 2 patients were taking three anticonvulsants.

The selection of anticonvulsants in our study was carried out in accordance with the recommendations of the International League Against Epileptic Disease (ILAE 2001-2004), taking into account clinical manifestations and EEG data from the standpoint of “evidence-based medicine”.

The etiology of epilepsy in 45 patients (37.5%) was associated with perinatal factors, in 24 patients (20%) - with congenital anomalies of brain development, in 14 patients (11.7%) - with craniocerebral trauma, in 5 patients (4.1%) - with tuberous sclerosis, in 31 patients (26.7%) - with previous infectious diseases of the nervous system. Among the patients, perinatal CNS lesions prevailed among the etiological factors.

When analyzing the anamnestic data of 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 puberty - in 8 patients (6.5%), in adolescence - in 4 patients (3%). In most patients, epilepsy most often debuted in late childhood.

Phenobarbital was administered to children aged 1 to 10 years. Among patients receiving carbamazepine, valproic acid preparations, and topiromate, the largest subgroups were patients aged 7 to 10 years and early adolescents (11 to 14 years). The largest subgroup was adolescents (15 to 17 years) in the sample of patients receiving lamotrigine.

The study analyzed the age-related effectiveness of antiepileptic drugs in the study group of patients. The percentage was calculated from the total number of patients taking a certain drug. When assessing the effectiveness of anticonvulsant therapy, the following indicators were assessed: remission, seizure reduction by more than 50%, seizure reduction by less than 50%, increased seizure frequency, and no effect. A positive result was considered to be remission + seizure reduction by more than 50%, a negative result was considered to be therapy ineffectiveness (increased seizure frequency + no effect).

When taking medications:

• In 1 patient aged 1 to 3 years, barbiturates achieved remission; in 2 patients of preschool and primary school age, there was no effect from barbiturate therapy;
• benzodiazepines in 2 patients (28.8%) aged 4 to 10 years achieved clinical remission of epilepsy, in 1 patient of primary school age (14.3%) seizures became more frequent, and in 4 patients (57.1%) there was no effect from benzodiazepine therapy. Clonazepam was equally ineffective when used in all age groups;
• carbamazepine in 22 (44%) patients, complete clinical remission of epilepsy was achieved, in 2 (4%) patients the seizures became more frequent, and in 26 (52%) patients there was no effect from carbamazepine therapy. In all cases of increased seizure frequency, carbamazepine was gradually discontinued;
• Valproic acid achieved clinical remission in 23 patients (50%), attacks became more frequent in 3 patients (6.5%), and resistant course was observed in 20 patients (43.5%). Valproates were less effective when used in groups of children aged 7 to 10 years and 11 to 14 years - 6 patients (13%) each, 4 to 6 years and 15 to 17 years - 5 patients (10.9%) each. The greatest effectiveness of valproates was noted in the group aged 1 to 3 years - 5 out of 6 patients in this group achieved remission; lamotrigine had a significant positive effect - complete clinical remission of epilepsy was achieved in 12 patients (85.7%), and there was no effect from lamotrigine therapy in 25 patients (14.3%). Lamotrigine was ineffective when used in a group of children aged 15 to 17 years - in 2 (14.3%) patients;
• Topiramate resulted in complete clinical remission of epilepsy in 33 (70%) patients, in 1 (2.1%) patient seizures became more frequent, and 13 (27.7%) patients remained resistant to therapy. In the group of children aged 1 to 3 years, remission was achieved in 4 (8.5%) patients, and in 1 patient the course was resistant. In the group of preschool children, remission was achieved in 7 (14.9%) patients, and 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, and 4 (8.5%) patients were resistant to therapy. In the group of children aged 11 to 14 years, remission was achieved in 9 (19.1%) patients, and in 2 (4.3%) patients complete relief of seizures was not achieved. In adolescence, topiromate was effective in 6 (12.8%) patients, and resistant course was observed in 4 (8.5%) patients. Thus, topiromate was equally effective when used in all age groups.

The correlation analysis revealed that the greatest effect was demonstrated by carbamazepine in the 4-6 year age group for temporal lobe epilepsy, TBI as an etiologic factor, and onset in late childhood; valproates in the 1-3 year and 7-10 year age groups for occipital and parietal epilepsy, congenital malformations, and perinatal lesions as etiologic factors, and onset in early childhood; lamotrigine in the 11-14 year age group for frontal epilepsy, neuroinfections as an etiologic factor, and onset in pre- and puberty; topiramate in all age groups for temporal lobe epilepsy, congenital malformations, perinatal lesions, and tuberous sclerosis as etiologic factors, and onset in infancy and late childhood.

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

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

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]