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Published on: September 20, 2024
Effectiveness and tolerability of zonisamide in children with epilepsy: a retrospective review
Hui Jeen Tan1, Timothy R Martland, Richard E Appleton
1Department of Paediatric Neurology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
Insights
Zonisamide is a potentially effective antiepileptic drug for children with difficult-to-control epilepsy. While generally well-tolerated, some patients experienced side effects or a loss of seizure control over time.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Epilepsy affects a significant number of children worldwide.
- Refractory epilepsy in pediatric populations presents a challenge for treatment.
- Zonisamide is an antiepileptic drug with a known mechanism of action.
Purpose of the Study:
- To assess the efficacy and tolerability of zonisamide in pediatric epilepsy patients.
- To evaluate zonisamide as a treatment option for refractory seizures in children.
Main Methods:
- Retrospective review of case notes for 57 children under 19 years old with epilepsy.
- Patients received zonisamide treatment and were followed for at least 12 months.
- Included children with generalized, focal, or mixed epilepsy types, mostly refractory to prior treatments.
Main Results:
- 35.3% of patients achieved >=50% seizure reduction at 2 months; 25.5% maintained this at follow-up.
- Some patients experienced loss of efficacy or worsening of seizures over time.
- 43.9% reported adverse effects, leading to withdrawal in 17.6% of cases.
Conclusions:
- Zonisamide demonstrates reasonable effectiveness in a diverse group of children with poorly controlled epilepsy.
- The drug is generally well-tolerated, offering an additional therapeutic choice for refractory pediatric epilepsy.
- Long-term efficacy and tolerability require careful monitoring in individual patients.
Purpose:
To evaluate the effectiveness and tolerability of zonisamide in children with epilepsy.
Method:
Retrospective case note review of young people (less than 19 years) with epilepsy from three UK tertiary centres who received treatment with zonisamide and were followed up for a minimum of 12 months.
Results:
Fifty-seven children were included, aged 1.5-18.5 (median, 12) years. Thirty-three (57.9%) patients had generalised epilepsy, 21 (36.8%) focal epilepsy, and three (5.3%) a mixed, generalised and focal, epilepsy. Fifty-six of the 57 patients had been refractory to at least three previous antiepileptic drugs. The maintenance dose of zonisamide was [range (median)] 0.7-14 (5)mg/kg/day. The median duration of treatment for all patients was 12 (range 0.25-35) months. After 2 months of treatment, 51 patients remained on zonisamide, 18 (35.3%) of whom demonstrated a > or =50% reduction in seizure frequency. At the end of the follow-up period, there was a loss of effect for some patients. Thirteen (25.5%) of the 51 patients continued to demonstrate a > or =50% reduction in seizure frequency whilst two who had become seizure-free started having seizures again. Six (11.8%) had <50% reduction, twenty-four (47%) had no change, and eight (15.7%) had increasing seizures. Twenty-five (43.9%) patients reported unwanted effects although this contributed to the withdrawal of zonisamide in only ten (17.6%) patients.
Conclusions:
Zonisamide appeared to be a reasonably effective and generally well-tolerated antiepileptic drug in a heterogeneous group of 57 children with poorly controlled epilepsy and provides another treatment option for children with refractory seizures.
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