Do antiepileptic drugs differ in suppressing interictal epileptiform activity in children?
1Department of Pediatrics, the Division of Pediatric Neurology, Floating Hospital for Children at New England Medical Center, Boston, MA 02111, USA.
Insights
Valproate (VPA) and carbamazepine (CBZ) demonstrate superior suppression of interictal epileptiform activity compared to phenobarbital (PHB) in children. This finding highlights differences in drug efficacy for managing epilepsy beyond seizure control.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Epileptology
Background:
- Antiepileptic drugs (AEDs) aim to suppress seizures and may also reduce interictal epileptiform activity.
- Comparative efficacy of phenobarbital (PHB), carbamazepine (CBZ), and valproate (VPA) in suppressing interictal epileptiform activity in pediatric patients remains unclear.
Purpose of the Study:
- To compare the rates of suppression of interictal epileptiform activity by PHB, CBZ, and VPA in children.
- To determine if AEDs differ in their ability to clear epileptiform discharges on electroencephalograms (EEGs).
Main Methods:
- Retrospective analysis of 213 paired EEGs from pediatric patients before and after initiation of PHB, CBZ, or VPA.
- Assessment of interictal epileptiform activity clearance in the second EEG tracing following AED introduction.
- Subanalysis based on sleep state and type of discharge (focal vs. generalized).
Main Results:
- Overall suppression rates were 22% for PHB, 33% for CBZ, and 46% for VPA (P=0.005 for VPA vs. PHB).
- In sleep-state EEGs, suppression rates were 30% for PHB, 40% for CBZ, and 50% for VPA (P=0.005 for PHB vs. VPA).
- Valproate and carbamazepine showed greater efficacy in suppressing both focal and generalized epileptiform activity compared to phenobarbital.
Conclusions:
- Valproate and, to a lesser extent, carbamazepine are more effective than phenobarbital in suppressing interictal epileptiform activity in children.
- These findings suggest distinct mechanisms or potencies among these AEDs regarding EEG discharge suppression.
- The choice of AED may influence not only seizure control but also the normalization of EEG epileptiform activity.
Abstract:
Antiepileptic drugs may suppress interictal epileptiform activity in addition to suppressing seizures, although the comparative rates of suppression of interictal epileptiform activity for phenobarbital (PHB), carbamazepine (CBZ), and valproate (VPA) in children are unknown. Electroencephalogram (EEG) pairs were identified in which the first tracing illustrated interictal epileptiform activity before antiepileptic drug treatment; the rate of clearance of such activity in the subsequent tracing was assessed according to the drug introduced. EEG pairs (n = 213) were identified for CBZ, PHB, and VPA. Overall suppression rates of epileptiform activity in the second EEG were 12/55 (22%) for PHB, 27/81 (33%) for CBZ, and 35/77 (46%) for VPA (P = 0.005 for VPA vs PHB). When suppression rates were assessed comparing sleep-state pairs, suppression rates were 24/80 (30%) for PHB, 51/129 (40%) for CBZ, and 60/120 (50%) for VPA (P = 0.005 for PHB vs VPA). A subanalysis for focal discharges yielded suppression rates of 10/43 (23%) for PHB, 19/60 (32%) for CBZ, and 8/19 (42%) for VPA; for generalized discharges, 2/12 (17%) for PHB, 8/21 (38%) for CBZ, and 27/58 (47%) for VPA. VPA, and to a lesser extent CBZ, appeared superior to PHB in suppressing interictal epileptiform activity, including both focal and generalized epileptiform activity.
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