Antiepileptic drugs and seizure aggravation

Abstract

Objective. To analyze epileptic seizure aggravation associated with antiepileptic drugs (AED) in adult patients. Material and methods. We examined 1407 patients aged 18-89 years. Different patterns of seizure aggravation were identified in 103 patients. Results. Aggravated seizures due the generic substitution were found in 32 patients. First was topiramate (TPM) (n=12), followed by valproates (VPA) (n=8), carbamazepine (CBZ) (n=5), lamotrigine (LTG) (n=1) and levetiracetam (LEV) (n=1). Patients with idiopathic generalized epilepsies (IGE) suffered aggravation with CBZ in 17 cases, VPA - in 6, TPM - in 6, LTG - in 1 and LEV - in 1. CBZ aggravated absences in patients with juvenile absence epilepsy (JAE) were found in 5 cases of 17 (29.4%), with childhood absence epilepsy (CAE) - in 1 of 24 (4.2%), absences and myoclonic jerks in juvenile myoclonic epilepsy (JME) - in 9 of 47 (19.1%), absences with eyelid myoclonus (Jeavons syndrome) - in 2 of 11 (18.2%). Seizure aggravations with different AEDs were observed in 13 patients. This pattern of aggravation was associated with resistant epilepsy and poor prognosis. Seizure aggravation due to increasing the dose of AEDs was found in 10 cases and associated with resistant epilepsy and poor outcome. "True" aggravation was associated with CBZ in 34 patients, including 16 IGE patients, with TPM - in 13, VPA - 5, LTG - 5, LEV - 2 and with clonazepam in 1 patient. Most often seizure aggravation was associated with CBZ in IGE patients (8.3%), and with LTG, TPM and CBZ in patients with other epileptic syndromes (non IGE): 4.9%, 4% and 3.7%, respectively. Conclusions. Different AEDs can cause aggravation. Seizures aggravation after generic substitution was characteristic of TPM most frequently. Seizure aggravation with different AEDs and due to increasing the dose of AEDs was associated with poor outcome. In all cases, seizure aggravation was more frequently caused by LTG (4.7%), CBZ (3.7%) and TPM (3.3%). To reduce the risk of aggravation, slow AEDs titration and keeping a diary of seizures are required.