Antiepileptic Drugs In Children Research Articles

Effect of valproic acid monotherapy on serum leptin and ghrelin levels in epileptic children (literature review)

The incidence of epilepsy varies between industrialized countries and developing ones. Anti-epileptic drugs are the standard of care for epilepsy management with sodium valproate being the most commonly prescribed anti-epileptic drug in children with epilepsy. Valproic acid (VPA) is a first generation anti-epileptic drug used widely as a monotherapy or part of polytherapy for a variety of seizures in children more than two years of age. It is stated that long-term treatment with VPA is associated with risks such as weight gain, hyperinsulinemia, metabolic syndrome, and cardiovascular disease. However,the exact pathogenesis of weight gain has not been clearly identified pathogenetically. Studying the effect of VPA monotherapy on possible causative factors (leptin and ghrelin levels) of weight gain would help in undertaking appropriate preventive actions alongside VPA therapy. We review the available literature on the research carried out on this subject in the following sections.

Bone Health and Antiepileptic Drugs in Children with Epilepsy: A Pilot Study

Epilepsy, a chronic neurological disorder necessitating prolonged antiepileptic medication, has been associated with deficiencies in vitamin D and related bone disorders in children. This study aims to investigate the prevalence of vitamin D deficiency, calcium deficiency, and bone diseases in children undergoing antiepileptic drug (AED) therapy. A retrospective study was conducted on 60 children (0-16 years old) with epilepsy at King Fahad Specialist Hospital-Dammam from 2016 to 2018. Participants were administered 800 IU/day of vitamin D for 6 months. Comprehensive assessments, including tests for calcium, phosphorus, 25-hydroxyvitamin D (25-OHD), 1,25-hydroxyvitamin D (1,25 OHD), parathyroid hormone (PTH), thyroid function [thyroid-stimulating hormone (TSH)], alkaline phosphatase (ALP), and bone density, were performed after 6 months of oral vitamin D supplementation. No significant associations were observed between age, sex, age of onset, duration of epilepsy, symptoms of vitamin D deficiency, dietary factors, and the levels of calcium, phosphorus, 25-OHD, 1,25-OHD, PTH, TSH, ALP, and bone scan. Carbamazepine (CBZ) was the only AED that affected bone metabolism in general (P = 0.024). Calcium was mostly found to be abnormal after using AED with vitamin D (800 IU/day) for 6 months (P = 0.05). 25-OHD deficiency was associated with use of CBZ in pediatric epilepsy. Considering its potential impact on bone metabolism, higher vitamin D doses may be advisable for children on long-term AED therapy to mitigate these abnormalities.

The Prevalence of Serum Anti Nuclear Antibodies in Children Treated With Anti-Epileptics

To evaluate the prevalence of positive serum antinuclear antibody (ANA) in children with epilepsy using three major antiepileptic drugs (phenytoin, carbamazepine and ethosuximide), 60 children under 18 years with epilepsy who were referred to pediatric neurology clinic or had admitted to neurology ward in Children Hospital in Tehran, Iran, were entered our study. They had been treated with one of the three antiepileptic drugs (carbamazepin, phenytoin, ethosuximide) with suitable dose for at least one month. The patients were divided into two groups according to the classification of the International League Against Epilepsy (ILAE): drug-resistant and drug-responsive. We studied the epidemiological and clinical characteristics and also serum ANA of the patients in both groups. In this research, we studied ANA in 60 epileptic children. 30 patients were diagnosed with drug resistant epilepsy and the other 30 were drug responsive. None of them showed the clinical manifestations of lupus erythematosus. As a whole, 7 patients (11.7%) were ANA-positive, 6.7% of drug resistant and 16.7% of drug responsive group showed this finding. There was no relationship between drug resistancy and ANA according to statistical studies (P=0.21). Although in our study, epidemiological and clinical data of the patients was reported in two separate groups of resistant or responsive to antiepileptic drugs, and no meaningful statistical difference was found between these two groups. Overally in our study, the prevalence of positive ANA in patients receiving antiepileptic drugs was less in comparison with previous studies and was more common in males. Finally, we suggest a more comprehensive and extensive study with more cases and further follow-up period in order to find the cause of immunological reactions to antiepileptic drugs in children with epilepsy.

If the Patient Does Not Take the Medication, It Will Not Work

AN UNWANTED EFFECT OF ANTIEPILEPTIC DRUGS IN CHILDREN: Adriana Ulate-Campos, Iván Sánchez Fernández Seminars in Pediatric Neurology Volume 24, Issue 4, November 2017, Pages 320-330 Epilepsy is one of the most common neurological disorders and, despite optimally chosen and dosed antiepileptic drugs (AEDs), approximately 20%-30% of patients will continue to have seizures. Behavior and cognition are negatively impacted by seizures, but AEDs are also a major contributor to behavioral and cognitive deficits. However, the cognitive and behavioral effect of AEDs in children is insufficiently emphasized in the literature. This review summarizes the cognitive and behavioral effects of AEDs in the pediatric population with the objective of helping pediatricians and pediatric neurologists to select the AEDs with the best profile for their individual patient's needs.

Metabolic Derangements with Anticonvulsants in Children with Generalised Tonic-clonic Epilepsy: A Cross-sectional Study

Introduction: Epilepsy is one of the most prevalent noncommunicable neurologic conditions, accounting for significant disability and mortality. The effects of Antiepileptic Drugs (AEDs) on total cholesterol, triglycerides, High-Density Lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and apolipoprotein levels have been demonstrated in many studies, mainly conducted with adults. However, there have been very few studies in children. Derangement of lipid profile and other metabolic abnormalities could lead to the development of metabolic syndrome in children. The adverse metabolic effects of anti-epileptics are underestimated, as only a few studies have been done in this area, which is a legitimate concern. Aim: To assess the impact of AEDs on metabolic parameters in children with epilepsy. Materials and Methods: This was a descriptive, crosssectional study conducted in the Department of Paediatrics and Pharmacology at Pt. BD Sharma PGIMS, Rohtak, Haryana, India. The study included 100 children with epilepsy from May 2022 to October 2022. A predefined case record form, including demographic and clinical characteristics, was filled for each participant. The parameters recorded were age, gender, outpatient number, type of epilepsy, history of duration of epilepsy, current AED history, and seizure frequency over the preceding six months, as per the case record form. Guidelines from the International Diabetes Federation were used for diagnosing metabolic syndrome in children. The data was entered into Microsoft excel and presented using descriptive statistics. The chi-square test was used to differentiate between categorical variables. Results: The mean age of the study participants was 10.2±2.97 years. There were more males (62%) than females (38%). A 48% of the patients received monotherapy, while 52% received polytherapy. A total of 24% of the patients had derangement in lipid profile (increased triglycerides and decreased HDL), with 14% of patients on monotherapy and 10% on polytherapy. The difference in metabolic derangements between monotherapy and polytherapy was not statistically significant (p=0.25). Out of 100 participants, 3% fulfilled the criteria for metabolic syndrome, with a predominance in males. Conclusion: Metabolic derangements are known with 1st generation AEDs, but 2nd generation AEDs can also lead to significant metabolic abnormalities.

Is there a relationship between socioeconomic factors and prevalence, adherence and outcome in childhood epilepsy? A systematic scoping review.

Socioeconomic factors play a role in the outcome of chronic diseases in childhood. Epilepsy is the most common chronic neurological disease in childhood. The relationship between socioeconomic factors and prevalence, adherence and outcome in children with epilepsy has not been systematically reviewed and therefore the aim of our study. Searches were conducted in PubMed, Embase and Cochrane databases from the first documented publications until 31st May 2020. The keywords included socioeconomic status, epilepsy, anticonvulsant, children and systematic review. The search generated 4687 abstracts. 26 articles were included in the final analysis after the screening process. We found one paper regarding prevalence, 12 regarding adherence and 13 regarding outcome and their relationship to socioeconomic factors. Socioeconomic factors of caregivers impacted school performance, seizure freedom, quality of life and risk of unemployment in adulthood. Lower socioeconomic status was associated with non-adherence. Epilepsy may be more prevalent in children living in lower socioeconomic neighborhoods. Socioeconomic factors of the caregiver, especially their level of education, annual income and marital status, had a significant impact on the outcome and adherence to anticonvulsants in children with epilepsy. Children belonging to a lower socioeconomic group are at risk of having poorer outcomes regarding adherence and hence remission, quality of life and academic achievement. We need to recognize this important aspect and take it into account when making a treatment plan for children with epilepsy.

Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study.

BackgroundEpilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy.MethodsA cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky’s medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence.ResultOne hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence.ConclusionAdherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.

Prehospital benzodiazepine use and need for respiratory support in paediatric seizures

BackgroundParamedics are frequently called to attend seizures in children. High-quality evidence on second-line treatment of benzodiazepine (BZD)-refractory convulsions with parenteral long-acting antiepileptic drugs in children has become available from the...

Effect of Antiepileptic Drugs on Serum Lipid Profile among Children with Epilepsy at a Tertiary Care Hospital, Chennai, India

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for atleast 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density LipoproteinCholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value &lt;0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value &lt;0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value &lt;0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value &lt;0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value &lt;0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value &lt;0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value &lt;0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value &gt;0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value &lt;0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value&lt;0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value &lt;0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile.

Clinical profile, evaluation of imaging guidelines, and management of pediatric traumatic brain injury at a tertiary care center in India: A review of 269 patients

Abstract Background: Traumatic brain injury (TBI) is associated with considerable morbidity and mortality in the pediatric population. Literature regarding management of TBI in children is scarce in the Indian setting. Our study aims to bridge the existing literary gap. Materials and Methods: This study is a retrospective analysis of 269 children below 12 years of age presenting to a tertiary care hospital in India with head injury between January 2018 and January 2021. Pearson’s χ2 test, Kruskal–Wallis test, and Mann–Whitney U-test were used for statistical analysis. Results: The mean age of children admitted with head injury was 4.7 years. TBI was mild in 92.2% of children. A fall from height was the most common cause of injury (81.8%). The most common finding on computed tomography (CT) was skull fracture in 38%. Ten children (3.8%) required neurosurgical intervention. The median duration of hospital stay was 4 days. Statistically significant differences in median duration of hospital stay were obtained based on skull fracture and Glasgow Coma Scale on arrival. About 43.1% (n = 116) of children received a CT scan despite lack of indication as per NICE (National Institute of Health Care and Excellence) guidelines, and positive findings were obtained in 47.4% (n = 55). Prophylactic anticonvulsants were given to 39.8% of children (n = 107), of which 86.8% (n = 92) had positive findings. Fourteen children (13.2%) with a normal CT scan received anticonvulsants due to the presence of seizures following head injury. Conclusion: Strict implementation of guidelines issued by NICE would have led to non-detection of intracranial injury in many patients. A modification of this guideline to suit the Indian perspective may be necessary. The use of anticonvulsants in children following head injury needs further characterization.

Children with idiopathic generalized epilepsy those underwent at least two years seizure remission: a retrospective analysis

Background: The aim of the retrospective study was to evaluate the effectiveness of the index antiepileptic drugs in children with idiopathic generalized epilepsy who underwent at least 2 years remission.Methods: A total of 52 children with idiopathic generalized epilepsy who underwent at least 2 years remission were identified retrospectively from the records of the paediatric and neurology care clinic from April 2017 to December 2020.Results: The seizure patterns of 52 cases were tonic-clonic seizures alone (73%), a combination of tonic-clonic seizures and absences (13.5%), and combined tonic-clonic seizures and myoclonus (13.5%). The total number of seizures at enrolment in all (age at seizure onset 7.44±5.12 years, male-female ratio (31:21) was 651 (mean 12.52±26.60). The total number of follow-up visits in all was 6.62±14.44 consisting of 1177.5±772.86 days of follow-up periods. All patients continued index antiepileptic drugs with initial target doses varies from low to moderate ranges. Add-on therapy was initiated in 43% of cases around the titration phase of index antiepileptic drugs (i.e. very early add-on). Treatment trends reveal increased use of 1st generation antiepileptic drugs than 2nd and 3rd generation. 2 years seizure remission rates were 55.77% by index antiepileptic drugs only therapy and 44.23% by very early add-on therapy. The seizure remission period was mean±SD 858.71±209.08 days.Conclusions: Index antiepileptic drugs with low to moderate initial target doses lead to achieving 2 years or more seizure remission. Very early add-on therapy is the novelty and leads to achieving the goal.

Long-term effectiveness and safety of antiepileptic drugs in children and adults

AIM: To conduct a retrospective comparative analysis of the efficacy and safety of epilepsy therapy with antiepileptic drugs.&#x0D; MATERIALS AND METHODS: The analysis of the treatment of 428 patients with epilepsy at the Childrens City Hospital No. 8 in Kazan, receiving antiepileptic drugs.&#x0D; RESULTS: It was found that valproic acid is more effective in the treatment of idiopathic generalized epilepsies compared to focal epilepsies (p = 0.0006). Valproate and carbamazepine were the most effective in the treatment of focal epilepsy with short- and long-term follow-up. Valproic acid is more effective than topiramate (p = 0.02), oxcarbazepine (p = 0.003), and levetiracetam (p = 0.003) in the treatment of focal epilepsy in short- and long-term follow-up. Carbamazepine is more effective than topiramate (p = 0.01), oxcarbazepine (p = 0.02), and levetiracetam (p = 0.001) in the treatment of focal epilepsy in long-term follow-up. It was revealed that more often they complained about side effects when using carbamazepine (63.2%). Levetiracetam was found to be better tolerated compared to valproate (p = 0.0006) and carbamazepine (p = 0.0006). Topiramate is better tolerated than carbamazepine (p = 0.02) and valproate (p = 0.03). Oxcarbazepine is better tolerated than carbamazepine in women (p = 0.04).&#x0D; CONCLUSIONS: When choosing an antiepileptic drug, it is necessary to be guided by the principle: first the basic, and then the drugs of the next generations, in the future, rely on information about the tolerability of the drug. It is necessary to evaluate the therapeutic effect of antiepileptic drugs with long-term observation, and use the criterion of complete absence of seizures as an indicator of the effectiveness of drugs.

Efficacy of the ketogenic diet on ACTH- or corticosteroid-resistant infantile spasm: a multicentre prospective control study.

To determine the efficacy of ketogenic diet (KD) therapy on adrenocorticotropic hormone- (ACTH) or corticosteroid-resistant infantile spasm (IS), and identify relevant associated factors. A prospective controlled study was undertaken at 10 tertiary children's medical centres in mainland China. Participants were non-randomly assigned to KD therapy or control (adjustment of antiepileptic drugs). The primary outcome was the reduction in spasms and remission of hypsarrhythmia at the 16th week, divided into Grade I (spasm-free for at least one week with hypsarrhythmia remission), Grade II (≥50% spasm reduction and/or hypsarrhythmia remission) and Grade III (<50% spasm reduction with hypsarrhythmia). In total, 227 patients were recruited and assigned to the KD (135 patients) and control (92 patients) groups. The efficacy in the KD group was superior to that in the control group (Grade I: 13.4% vs. 10.9%; Grade II: 40.7% vs. 20.7%, p=0.025). Patients with a ketogenic ratio <3:1 had a higher rate of Grade I than those with ketogenic ratio ≥3:1 (66.7% vs. 33.3%, p=0.037). No significant correlation was found between the efficacy of KD and level of serum ketosis, aetiology of IS, or age. The efficacy of KD therapy was superior to adjustment of oral antiepileptic drugs in children with ACTH- or corticosteroid-resistant infantile spasms.

Recurrence of Epilepsy and Related Risk Factors after the Discontinuation of Antiepileptic Drugs in Children: A 10-Year Single-Center Study

Recurrence of Epilepsy and Related Risk Factors after the Discontinuation of Antiepileptic Drugs in Children: A 10-Year Single-Center Study

Delayed hypersensitivity to antiepileptic drugs in children.

Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening. This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature. Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.

Antiepileptic Drugs-Induced Enuresis in Children: An Overview.

Objective: To evaluate enuresis-induced antiepileptic drugs in children. Data Sources: A PubMed search (1917 to July 2020) was performed using the following keywords and associated medical subject headings: antiepileptic drugs, enuresis, pediatric population, drug-induced enuresis, and epilepsy. Study Selection and Data Extraction: The search was conducted to find the role of antiepileptic drugs-induced enuresis in children in studies published in English. Data Synthesis: Enuresis or bedwetting is an underreported adverse drug reaction of antiepileptic drugs. Owing to that fact, it is a condition that is outgrown with age and also could cause embarrassment. As antiepileptic drugs sometimes need to be taken for a long duration until epilepsy relapses, the occurrence of enuresis in this situation can be troublesome for both the child and the caretaker. Even though enuresis is proposed to have a significant effect on the child's psychology, it is still considered to be a condition that is outgrown with age. This article includes a review of antiepileptic drugs reported to have caused enuresis in children. Conclusions: If a child develops enuresis as an adverse drug reaction, this adds further challenges to their life. A better understanding of this potential adverse effect may help prevent unwanted stress. Though the exact mechanisms are not known, the hypothesis generated is from the occurred cases, most of which relapsed when the drug was withdrawn. Considering the gravity of epilepsy in children, more detailed studies need to be conducted on this adverse effect to ensure a safe and effective treatment in children.

CLINIC-ETIOLOGICAL PROFILE AND USE OF ANTIEPILEPTIC DRUGS IN CHILDREN PRESENTING WITH SEIZURES: AN OBSERVATIONAL STUDY.

Introduction: Seizures are one of the common causes for hospital admissions in children with significant mortality and morbidity. The present investigation was aimed to study the clinic-etiological profile and use of antiepileptic drugs in children presenting with seizures.&#x0D; Methods: The present prospective observational study was conducted in the Department of Pediatrics, SKMCH Medical College and Hospital, Bihar for the period of 1 year from Nov 2017 to Nov 2018. A total of 120 children with acute symptoms and signs of seizures with altered sensorium were studied. History was obtained to determine the possible cause of the seizure and type of epilepsy. The data obtained was analyzed with SPSS version 20.&#x0D; Results: out of total 120 children majority were found in the age group of 1-4 years and males had higher prevalence compared to female. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen. Uconsciousness 51.7%, fever 40.8%, vomiting 26.7%, and headache 20% were the leading presenting complaints in seizure patients.&#x0D; Conclusions: The study showed primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by simple partial seizures. Effort should be intensifying to eradicate the preventable causes of the disease.&#x0D; Keywords: Epilepsy, Fever, Children

Dried Blood Microsampling-Based Therapeutic Drug Monitoring of Antiepileptic Drugs in Children With Nodding Syndrome and Epilepsy in Uganda and the Democratic Republic of the Congo.

Nodding syndrome is a highly debilitating, generalized seizure disorder, affecting children in subregions of sub-Saharan Africa. Despite numerous efforts to uncover the etiology, the exact cause of this syndrome still remains obscure. Therefore, to date, patients only receive symptomatic care, including the administration of first-generation antiepileptic drugs for seizure control. As data on the efficacy of drugs within this population are completely lacking, the aim of this study was to explore how therapeutic drug monitoring could help to understand the differential response to therapy. Considering the challenging environment in which sampling had to be performed (remote areas, devoid of electricity, running water, etc), dried blood matrices [ie, dried blood spots (DBSs)] and volumetric absorptive microsampling (VAMS) were considered fit-for-purpose. In addition, owing to the similarities between the syndrome and other forms of epilepsy, samples originating from patients suffering from (onchocerciasis-associated) epilepsy were included. In total, 68 patients with Nodding syndrome from Uganda, 58 Ugandan patients with epilepsy, and 137 patients with onchocerciasis-associated epilepsy from the Democratic Republic of the Congo were included. VAMS samples and DBS were analyzed using validated methods, involving manual extraction or fully automated extraction, respectively, before quantification using liquid chromatography coupled with tandem mass spectrometry. Analysis revealed that serum concentrations (calculated from DBS) within the respective reference ranges were attained in only 52.9% of the 68 Nodding syndrome patients treated with valproic acid, in 21.4% of the 56 Ugandan epilepsy patients treated with carbamazepine, and in 65.7% of the 137 onchocerciasis-associated epilepsy patients from the Democratic Republic of the Congo treated with phenobarbital. In all other instances, concentrations were subtherapeutic. Furthermore, on comparing DBS with VAMS concentrations, an inexplicable overestimation was observed in the latter. Finally, no obvious link could be observed between the obtained drug concentrations and the number of seizures experienced during the last month before sampling, elaborating the fact that the level of improvement in some patients cannot simply be linked to reaching therapeutic concentrations.

Prevalence of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy from western China: A cross-sectional survey

PurposeThe purpose of the study was to evaluate adherence to prescribed antiepileptic drugs (AEDs) and influencing factors in children with epilepsy from western China. MethodsIn this cross-sectional study, children with epilepsy were recruited from Western China Second Hospital. Questionnaires were used to collect baseline patient data and medication adherence, which was assessed using the Morisky scale. An ordinal logistic regression model was used to examine the factors affecting medication adherence. ResultsIn total, 399 children were included. The age of participants ranged from 0.3 to 17.8 years, with a male-to-female ratio of 1.36:1. Overall, 57.1% (228/399) had generalized seizures. Further, 21.3% (85/399) patients showed good adherence, 51.4% (205/399) moderate adherence, and 27.3% (109/399) poor adherence. Ordered multiclassification logistic regression analysis showed that the age of patient, type of epilepsy, total household income, and source of drug information were associated with adherence. ConclusionsMedication adherence is not high in children with epilepsy from western China. Medication adherence is affected by many factors, and we suggest that efforts are focused on tailored approaches to epilepsy education and behavioral interventions for better adherence.

Adverse Drug Reactions of Anti-Epileptic Drugs in Children with Epilepsy: A Cross-Sectional Study.

Background:Adverse drug reactions (ADRs) due to antiepileptic drugs (AEDs) in children contribute to poorer patient outcomes. However, reliable data ragarding such ADRs is not available.Objectives:Thus, the aim of the present study was to determine the incidence and patterns of ADRs of antiepileptic drugs in children aged 2-17 years presenting to a tertiary care teaching hospital.Methods:An observational study was conducted in the Department of Pediatrics, Kalawati Saran Children’s Hospital for a period of one year. Two hundred consecutive eligible patients (aged 2-17 yrs with epilepsy on AED) with consenting parents were enrolled. ADRs were noted using Paediatric Epilepsy Side Effect Questionnaire (PESQ) at clinic visits and any other ADRs reported by parents were also recorded. Causality, severity and avoidability assessments were done.Results:The mean age was 10.5 ± 3.6 years. A total of 139 ADRs occurred in 97 patients. One hundred and nine ADRs were reported by use of PESQ, in addition, 30 ADRs were reported by parents. Poor school result (33.8%) was the commonest ADR. Valproate (61.9%) was the main drug causing ADRs. Valproate, when used in polytherapy, was associated with more number of children experiencing ADRs (72.2%). The most common add on drug was clobazam (42.3%). Children with poorly controlled epilepsy were associated with more ADRs. Causality assessment revealed that 91.3% of the ADRs were probable. Most (94.9%) ADRs were of ‘mild’ category and 95.7% were probably preventable. Treatment was discontinued only in 6 patients of phenytoin toxicity.Conclusion:Cognitive and neurological problems were the most common ADRs seen in children with epilepsy. Polytherapy significantly increases the likelihood of ADRs in children.