THE USE OF ANTIEPILEPTIC DRUGS IN CHILDREN WITH EPILEPSY – OUR CURRENT STATUS

Objectives: For patients with documented epilepsy, antiepileptic drug (AED) is the mainstay of treatment. 60–70% of patients enter long-term remission, most on single AED. Phenytoin, carbamazapine and sodium valproate are the three 'established' drugs, most commonly used with similar effectiveness. Since 1990s, many new AEDs have been licensed. Vigabatrin, lamotigine, topiramate and gabapentin are available at our hospital for years. We would like to share our experience of the AED treatment in childhood epilepsies with all the attendants.

Methods: We reviewed all the patients who have been given a diagnosis of epilepsy, free of active cerebral pathology, being regularly followed up at our neurological clinic for at least 6 months between October 2001 and October 2005. They are either previously treated or untreated (newly diagnosed). Only those who still visit our clinic in October 2005 or those AEDs had been discontinued at our plan during this period, are enrolled. We recorded the AEDs currently or lastly used and the status of seizure control.

Results: A total of 212 children were identified. The present age was mean 10.1 SD 5.5 years.. The age of onset was mean 4.2 SD 3.8 years. The follow-up duration was 4.1 years. There were 84 girls and 128 boys. 63 (29.7%) patients were classified as having idiopathic epilepsy, 66 (31.1%) as cryptogenic and 83 (39.2%) as symptomatic. In October 2005, 131 (61.79%) patients were on monotherapy (VPA and CBZ for 80%), 70 (33.0%) duotherapy (26 on VPA+LTG), and 11 (5.2%) triple drugs (8 on VPA+LTG+CZP). 128 (60.4%) were seizure-free, 33 (15.6%) still refractory, and the others 51 (24.1%). The seizure-free rate is much higher in idiopathic epilepsy (90.5%) than cryptogenic epilepsy (31.1%) or symptomatic epilepsy (39.2%) (p<0.001).

Conclusion: For children with epilepsy, the majority of our patients are using one drug, most on VPA (42.6%) or CBZ (36.6%) and next TPM (9.9%), VGB (6.1%). VGB is the first drug of choice in patients with infantile spasm here. In duotheray, 26/70 patients are on VPA+LTG which is the most common combination therapy reported to have synergistic effect. 11 patients are using three AEDs. The seizures are still refractory in 10/11 patients. Doose syndrome, Dravet syndrome and Lennox-Gastaut syndrome account for 63.6% (21/33) in our refractory group.