Felbamate for pediatric epilepsy-should we keep on using it as the last resort?
Shira Rabinowicz1,2, Tal Schreiber2, Gali Heimer1,2
1Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.
Insights
Felbamate is an effective anti-seizure medication for children with difficult epilepsy, showing significant seizure reduction in over half of patients. It is generally safe, with manageable side effects, making it a viable option for pediatric epilepsy treatment.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Epileptology
Background:
- Concerns about felbamate's adverse effects limit its use in pediatric drug-resistant epilepsy.
- Identifying patient subgroups who benefit most from felbamate is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of felbamate in children with drug-resistant epilepsy.
- To determine which pediatric patients may achieve the greatest benefit from felbamate therapy.
Main Methods:
- Retrospective review of medical records from a tertiary pediatric epilepsy clinic (2009-2021).
- Assessment of drug efficacy within the first 3 months and ongoing monitoring of therapeutic response and adverse reactions.
Main Results:
- 75 children with epilepsy were included; 51% achieved ≥50% seizure reduction, and 12% had a complete response.
- 25% experienced adverse reactions, including elevated liver enzymes and neutropenia, but treatment was generally continued.
- Children with intractable epilepsy post-herpes encephalitis responded well to felbamate.
Conclusions:
- Felbamate demonstrates efficacy in treating pediatric epilepsy, including drug-resistant cases.
- The safety profile of felbamate in children is acceptable, with manageable adverse events.
- Felbamate is a valuable anti-seizure medication for the pediatric population.
Introduction:
Concerns regarding felbamate adverse effects restrict its widespread use in children with drug-resistant epilepsy. We aimed to examine the efficacy and safety of felbamate in those children and identify the ones who may benefit most from its use.
Methods:
We retrospectively reviewed the medical files of all patients who were treated with felbamate in a tertiary pediatric epilepsy clinic between 2009-2021. Drug efficacy was determined at the first 3 months of treatment and thereafter. Therapeutic response and adverse reactions were monitored throughout the course of treatment.
Results:
Our study included 75 children (age 8.9 ± 3.7 years), of whom 53 were treated with felbamate for seizures, 16 for electrical status epilepticus during sleep and 6 for both. The median follow-up time was 16 months (range 1-129 months). The most common cause for epilepsy was genetic (29%). The median number of previous anti-seizure medications was six [4-8]. A therapeutic response ≥50% was documented in 37 (51%) patients, and a complete response in 9 (12%). Nineteen patients (25%) sustained adverse reactions, including three cases of elevated liver enzymes and one case of neutropenia with normal bone marrow aspiration. In all cases, treatment could be continued. All children with intractable epilepsy following herpes encephalitis showed a response to felbamate.
Conclusion:
Felbamate is an efficacious and safe anti-seizure medication in the pediatric population.
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