Related Experiment Videos
Changes in serum anticonvulsant levels with febrile illness in children with epilepsy
K J Goulden1, P R Camfield, C S Camfield
1Department of Pediatrics, Dalhousie University, Halifax, N.S., Canada.
Insights
Intercurrent illnesses can alter anticonvulsant medication levels in children with epilepsy, potentially causing toxicity or reduced seizure control. Monitoring serum levels during and after illness is crucial for effective epilepsy management.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Epilepsy management in children requires stable anticonvulsant (AC) serum levels.
- Intercurrent illnesses and their treatments can unpredictably alter AC levels, risking toxicity or breakthrough seizures.
Purpose of the Study:
- To prospectively investigate the impact of intercurrent febrile illness on serum anticonvulsant levels in children on monotherapy.
- To identify potential interactions between febrile illness, its treatment, and AC serum concentrations.
Main Methods:
- Prospective study of 111 children with epilepsy on AC monotherapy.
- Measurement of free and total serum AC levels during wellness, febrile illness (day 5), and post-recovery.
- Analysis of 55 febrile illness episodes in 39 children.
Main Results:
- Twelve illnesses (21.8%) were linked to significant changes in serum AC levels.
- Seven children experienced clinical toxicity; one had increased seizure activity.
- Observed AC level alterations suggested interactions with antibiotics, antipyretics, or viral infections, though amoxicillin and acetaminophen showed no apparent interaction.
Conclusions:
- Intercurrent febrile illnesses frequently cause significant fluctuations in serum anticonvulsant levels in children.
- Physicians must recognize the potential for complex interactions between febrile illnesses and AC therapy.
- Awareness and monitoring are essential to prevent toxicity and maintain seizure control in pediatric epilepsy patients.
Abstract:
Changes in anticonvulsant serum levels during intercurrent illness may cause toxicity or decreased seizure control in children with epilepsy. We studied prospectively the effect of intercurrent illness and its treatment in 111 children being treated with AC monotherapy. Free fraction and total serum AC levels were determined when the child was well, on the fifth day of any illness with fever and one month after recovery. There were 55 episodes of febrile illness in 39 children during the study period. Twelve illnesses were associated with significant increases or decreases in serum AC levels; 7 children became clinically toxic; 1 child had increased seizures during illness. The mechanisms of AC level changes appeared to include interaction with antibiotics, with antipyretics or with viral illness. Amoxycillin and acetaminophen did not appear to interact with the AC's used. Physicians caring for children with epilepsy should be aware of the frequency and complexity of potential interactions between intercurrent febrile illness and anticonvulsant medication.