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[Exacerbation of seizures by carbamazepine in four children with symptomatic localization related epilepsy]
A Miyamoto1, S Takahashi, J Oki
1Department of Pediatrics, Asahikawa Medical College.
Insights
Carbamazepine (CBZ) can worsen seizures in children with symptomatic epilepsy, even at therapeutic levels. Alternative treatments like phenytoin may be more effective for seizure control in these cases.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Carbamazepine (CBZ) is a common antiepileptic drug for partial seizures.
- Symptomatic localization-related epilepsy presents unique treatment challenges in children.
Observation:
- Four children with symptomatic epilepsy experienced seizure exacerbation despite therapeutic CBZ serum levels.
- Seizure worsening included increased partial seizures and new atonic seizures.
- EEG abnormalities were noted in two children during CBZ treatment.
Findings:
- CBZ treatment led to more frequent and severe partial seizures in affected children.
- Discontinuation of CBZ and initiation of phenytoin resulted in seizure control and EEG improvement.
- Underlying conditions included hypoxic ischemic encephalopathy, head injury, and ectopic gray matter.
Implications:
- CBZ may paradoxically exacerbate seizures in specific pediatric epilepsy populations.
- Clinicians should consider alternative antiepileptic drugs for children with symptomatic localization-related epilepsy.
- Careful monitoring is essential when using CBZ in children with complex epilepsy syndromes.
Abstract:
We treated one hundred and seventy-eight epileptic children with carbamazepine (CBZ) for eight years. Among them, four children with symptomatic localization-related epilepsy, aged 11 months to 12 years, developed exacerbation of seizures. Their epilepsies were associated with hypoxic ischemic encephalopathy, head injury and ectopic gray matter. Despite the serum levels of CBZ (7.0 approximately 9.5 micrograms/ml) being within the therapeutic range, all of them had more frequent and severe partial seizures than before taking CBZ and one developed new atonic seizures. Diffuse irregular spike-wave complexes appeared on EEG in two children. Following discontinuation of CBZ in addition to replacement with phenytoin, their seizures became well-controlled and EEG findings improved except for residual focal spikes. Although CBZ is a widely used and effective antiepileptic drug for partial seizures, it should be kept in mind that CBZ may exacerbate seizures in children with symptomatic localization-related epilepsy.