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Higher evening antiepileptic drug dose for nocturnal and early-morning seizures
L M F F Guilhoto1, T Loddenkemper, M Vendrame
1Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Insights
Increasing evening doses of antiepileptic drugs (AEDs) effectively controlled seizures in most children. This strategy led to seizure freedom in 64.7% of patients, demonstrating its potential for managing nocturnal epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Nocturnal seizures present unique management challenges in pediatric epilepsy.
- Optimizing antiepileptic drug (AED) dosing, particularly evening administration, may improve seizure control.
Purpose of the Study:
- To evaluate the efficacy and safety of proportionally higher evening doses of AEDs in children with nocturnal or early-morning seizures.
- To assess seizure outcomes and side effects following AED dose modification.
Main Methods:
- Retrospective review of 17 children with nocturnal/early-morning seizures.
- Dose adjustment to proportionally higher evening administration of AEDs.
- Assessment of seizure frequency reduction and adverse events.
Main Results:
- 15 out of 17 patients (88.2%) responded to the adjusted dosing regimen.
- 11 patients (64.7%) achieved complete seizure freedom.
- No patients experienced seizure worsening; only two reported transient side effects (fatigue/somnolence).
Conclusions:
- Proportionally higher evening dosing of AEDs is an effective strategy for managing nocturnal and early-morning seizures in children.
- This dosing modification offers a favorable safety profile with significant seizure reduction and freedom rates.
- The approach is particularly beneficial for specific epilepsy syndromes like nocturnal frontal lobe epilepsy (NFLE).
Abstract:
We describe 17 children with nocturnal or early-morning seizures who were switched to a proportionally higher evening dose of antiepileptic drugs and were retrospectively reviewed for seizure outcome and side effects. Of 10 children with unknown etiology, clinical presentation was consistent with nocturnal frontal lobe epilepsy (NFLE) in 5 and benign epilepsy with centrotemporal spikes (BECTS) in 3. After a mean follow-up of 5.3 months, 15 patients were classified as responders; 11 of these became seizure free (5 NFLE, 1 BECTS, 5 with structural lesions) and 4 (2 BECTS, 2 with structural lesions) experienced 75-90% reductions in seizures. Among two nonresponders, seizures in one had failed to resolve with epilepsy surgery. Nine subjects (53%) received monotherapy after dose modification, and none presented with worsening of seizures. Two complained of transient side effects (fatigue/somnolence). Differential dosing led to seizure freedom in 64.7% (11/17) of patients, and 88.2% (15/17) experienced ≥ 50% reductions in seizures.
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