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Drug-resistant epilepsy in children with partial onset epilepsy treated with carbamazepine
Gewalin Aungaroon1, Katherine D Holland1, Paul S Horn1,2
1a Division of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.
Insights
Carbamazepine (CBZ) effectively treats newly diagnosed partial onset epilepsy in children, with over 80% achieving remission. However, nearly 9% develop drug-resistant epilepsy (DRE), highlighting the need to improve epilepsy surgery timelines.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Partial onset epilepsy is a common neurological disorder in children.
- Carbamazepine (CBZ) is a first-line antiepileptic drug.
- Understanding long-term outcomes and the development of drug-resistant epilepsy (DRE) is crucial for effective management.
Purpose of the Study:
- To evaluate the long-term outcomes of carbamazepine (CBZ) treatment in children with newly diagnosed partial onset epilepsy.
- To identify the incidence of drug-resistant epilepsy (DRE) and factors influencing epilepsy surgery in this cohort.
Main Methods:
- Retrospective review of medical records for 100 children with newly diagnosed partial onset epilepsy treated with CBZ.
- Telephone questionnaires for follow-up data collection.
- Analysis of seizure remission, recurrence, DRE diagnosis, and epilepsy surgery details.
Main Results:
- Long-term follow-up (mean 7.1 years) was available for 79 children.
- 83.5% achieved 2-year seizure remission, with 72.7% on CBZ monotherapy.
- 8.9% developed DRE, with 5 undergoing epilepsy surgery after a mean of 5.3 years from seizure onset.
Conclusions:
- CBZ is effective for achieving long-term seizure remission in most children with newly diagnosed partial onset epilepsy.
- A significant minority develop DRE, indicating a need for timely intervention.
- Prolonged duration to epilepsy surgery, influenced by seizure course and patient/family factors, requires attention for improved DRE management.
Objective:
To evaluate the outcome, including drug-resistant epilepsy (DRE) in children with newly diagnosed partial onset epilepsy treated with carbamazepine (CBZ).
Methods:
A retrospective medical records review and telephone questionnaire were undertaken on a total of 100 subjects.
Results:
Long-term follow-up was obtained on 79 children with a mean duration of 7.1 years from CBZ initiation. A total of 66 (83.5%) subjects achieved 2-year seizure remission, 48 (72.7%) subjects did so with CBZ monotherapy. Seven (10.6%) had seizure recurrence after 2-year seizure remission. DRE was diagnosed in seven (8.9%) subjects and five subjects had epilepsy surgery. The mean duration from seizure onset to epilepsy surgery was 5.3 (±2.1) years. Contributing factors for the prolonged duration from seizure onset to epilepsy surgery were identified including: relapsing-remitting course of seizure, family reluctance for epilepsy surgery and uncontrolled psychological problems.
Conclusions:
Over 80% of children with newly diagnosed partial onset epilepsy who were initially treated with CBZ achieved 2-year seizure remission, and more than 70% of this group did so with CBZ monotherapy. The majority of these patients maintained seizure remission overtime. However, 8.9% of this population met the criteria for DRE and most of them had epilepsy surgery. The duration from seizure onset to epilepsy surgery is an important potential area for improvement in DRE patient care.
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