Oxcarbazepine Treatment Research Articles

Retention rate of oxcarbazepine monotherapy in an unselected population of adult epileptics

In a retrospective study we assessed the outcome of oxcarbazepine (OXC) monotherapy in a naturalistic setting. We identified all adult patients who had been treated with OXC at a single neurological outpatient center. A total of 175 patients were identified, 97 of them used OXC as their first AED (Group I), and 78 as second monotherapy (Group II), after failure of a previous AED. The 1-year retention rates of OXC treatment were 91% for Group I and 77% for Group II. Discontinuations were due to adverse effects in 3 patients (3%) in Group I and in 11 patients (14%) in Group II, and due to lack of efficacy in 2 patients (2%) in Group I and in 6 patients (8%) in Group II. We conclude that OXC monotherapy is effective and well tolerated.

Oxcarbazepine Treatment of Juvenile-Onset Bipolar Disorder

Oxcarbazepine Treatment of Juvenile-Onset Bipolar Disorder

Oxcarbazepine Treatment of Juvenile-Onset Bipolar Disorder

Oxcarbazepine Treatment of Juvenile-Onset Bipolar Disorder

The effects of oxcarbazepine on oxidative stress in epileptic patients.

In the present study, erythrocyte lipid peroxidation, superoxide dismutase, glutathione peroxidase and catalase activities were determined in epileptic patients receiving oxcarbazepine monotherapy for 1 year and normal controls. Glutathione peroxidase, catalase, superoxide dismutase and malondialdehyde activities were investigated in a control group (15 normal healthy adults) and a group of 13 epileptic patients, before and after 1 year of oxcarbazepine treatment. The values of glutathione peroxidase and superoxide dismutase activities were statistically significant after 1 year of therapy and pretreatment. The values of malondialdehyde were significantly different from the normal subjects and pretreatment patients values. This study suggests that the antioxidant systems of epileptic patients receiving oxcarbazepine therapy for 1 year were significantly affected.

P.1.191 No clinically significant weight changes associated with long-term oxcarbazepine treatment

P.1.191 No clinically significant weight changes associated with long-term oxcarbazepine treatment

A pilot study of oxcarbazepine in treatment of dysphoria with increased impulsivity

A pilot study of oxcarbazepine in treatment of dysphoria with increased impulsivity

Oxcarbazepine Treatment of Posttraumatic Stress Disorder

Oxcarbazepine Treatment of Posttraumatic Stress Disorder

Long-term cohort study comparing medical (oxcarbazepine) and surgical management of intractable trigeminal neuralgia

Trigeminal neuralgia is a recurrent severe shooting neuropathic pain which can be managed both pharmacologically and surgically. However, there are no prospective data that compare these two therapeutic strategies. This study therefore aimed to assess long-term outcome in patients with intractable trigeminal neuralgia treated with oxcarbazepine and later with surgery. Fifteen patients (11 females) with trigeminal neuralgia intractable to available drugs (carbamazepine, phenytoin and baclofen), were prospectively followed for 13 years (1986–1999) with a total follow up time from onset of disease of 16±6 years (mean±SD), range 8–30 years. All patients were contacted in 1999 and 12 replied, two had died and one had last replied in 1996. Patients were first treated with oxcarbazepine 1200±600 mg daily dosage (mean±SD) and subsequently with surgery of their choice. The outcome measures used were: McGill Pain Questionnaire, Hospital Anxiety and Depression Scale, patient satisfaction questionnaire and clinicians' global evaluation. Pain control was initially achieved in all patients and oxcarbazepine was used continuously or intermittently for 4.0±3 years (mean±SD). Thirteen patients experienced some mild side effects and a dose-dependent hyponatraemia was noted. Subsequently, 12 patients required surgery (five microvascular decompressions and seven surgery at the level of the Gasserian ganglion) to control their pain and were followed up for 4.3±1.7 years post surgery (mean±SD). Three patients required repeat surgery to control their pain, which was successful in two. A further two patients continued with low dose medication post initially successful surgery. Three patients reported numbness and one hearing loss after surgery. Kaplan Meier analysis 3 years after oxcarbazepine use and then 3 years after surgery showed that the mean time for recurrence of pain after oxcarbazepine treatment was 10 months whilst for surgery it was 28 months ( P<0.0001). Pain free periods and types of complications post surgery varied and depended on the type of surgery performed. Due to the small numbers, it was not possible to analyse the different types of surgical procedures individually. Outcomes after any type of surgery were better on all evaluations and eight patients felt that they should have had surgery earlier. Oxcarbazepine is a potent antineuralgic drug with very good acceptability and tolerability. However, its effectiveness was rather short term necessitating surgical intervention. As surgery was associated with better outcome, patients may therefore benefit from having surgery earlier rather than later in the disease process in order to improve quality of life, freedom from medication and the need for regular follow up. Surgery does not provide pain relief for all patients. This is the first study that has compared outcome in a group of patients who have had both pharmacological and surgical treatments. As these data cannot be extrapolated to other antineuralgic drugs, similar comparative studies would be appropriate.

Oxcarbazepine in treatment of childhood epilepsy: A survey of 46 children and adolescents

Oxcarbazepine (OCBZ) is one of the new antiepileptic drugs (AEDs) currently available in several countries. While it is rated as having fewer side effects than carbamazepine (CBZ) there has been a paucity of studies in children. We retrospectively reviewed our results in 46 children (26 female, 20 male) with a mean age of 10.3 years (range: 1.3–17.9 years) with a mean duration of the epilepsy of 7.2 years. The patients previously were treated with three to 15 (mean 8.2) other AEDs. The mean dose of OCBZ was 56.7 mg/kg/d (range: 19–123 mg/kg/d); the mean blood serum level of monohydroxy derivative was 29.9 mg/l. The most common comedication was valproic acid. After 1 year follow-up, OCBZ was beneficial in 50%: one child had a seizure reduction of 50%–74%, 18 had a reduction of 75%–99%, and four became seizure free. We were not able to identify any relevant parameter as indicator whether OCBZ will be efficient or not. The spectrum of side effects was similar to that of CBZ. Despite the severity of the epilepsy in our patients, OCBZ was efficacious and safe and is a helpful advancement in the treatment of epilepsies.

Oxcarbazepine in the treatment of early childhood epilepsy.

Very little data are available on the usefulness of oxcarbazepine in young children with epilepsy. From January 1991 through October 1994, we treated 53 children under age 7 years with oxcarbazepine. The mean follow-up with oxcarbazepine treatment was 13 months. Etiology was symptomatic in 39, cryptogenic in 12, and idiopathic in 2 children. Forty-three children had previously been intractable to one or more antiepileptic drugs (including carbamazepine in 30 patients) and two had carbamazepine hypersensitivity. The age at onset of oxcarbazepine therapy ranged from 0.6 to 6.9 years (mean, 3.9 yr). The mean maximum oxcarbazepine dose was 50 mg/kg/day (range, 21-86 mg/kg/day). Of the children with localization-related epilepsy, 12 of 44 (27%) became seizure free and an additional 16 of 44 (36%) had an at least 50% reduction of seizures. Five of nine children with generalized epilepsy also had some benefit but none became seizure free. In the 33 children with at least 50% seizure reduction, the mean effective dose and trough serum level of the active metabolite monohydroxycarbazepine were 47 mg/kg/day (range, 21-75 mg/kg/day) and 91 micromol/L (range, 42-130 micromol/L), respectively. Efficacy was transient in 4 children; side effects were observed in 17 children (32%); in 9 (17%) of whom, they led to dose reduction or discontinuation. Oxcarbazepine appears to be an effective and well-tolerated drug for localization-related early childhood epilepsy. Young children need a higher dose per body weight than adults.

Carbamazepine-induced changes in plasma levels of neuroleptics.

We compared the effect of carbamazepine and oxcarbazepine treatment on the plasma levels of clozapine and thioridazine in 12 patients. There was a 47% decrease in the plasma levels of clozapine (p < 0.005, Students two-tailed t-test) during carbamazepine treatment, while the effects on the thioridazine levels were less marked (n.s.). Since carbamazepine is also used in patients receiving concurrent clozapine therapy, it is important to take this marked interaction between these two drugs into account.

Survey of 260 epileptic patients treated with oxcarbazepine (Trileptal ®) on a named-patient basis

We report the clinical findings on all 260 epileptic in- and out-patients of a Dutch epilepsy centre ever treated with oxcarbazepine on a named-patient basis. All but three patients had been previously treated, in vain, with carbamazepine. Of 260 patients, exposed for 935 patient-years, 161 were still treated on reference date, the longest duration of oxcarbazepine treatment being 119 months. Fourteen patients were lost to follow up. Four successfully stopped treatment after full control of their epilepsy for over three years. Seven stopped because they got worse instead of better. Seventy-three did not benefit sufficiently to continue on OCBZ in view of alternative treatment possibilities. In one patient the final diagnosis was pseudo-seizures. The drug is particular useful in patients who require polypharmacy and patients with adverse effects to carbamazepine.

Practical aspects of oxcarbazepine treatment.

In patients with refractory seizures, substitution of oxcarbazepine (OCBZ) for carbamazepine (CBZ) may be associated with reduced seizure frequency and an improved mental state. The recommended dosage of OCBZ as monotherapy for adults with epilepsy is 600-1,200 mg orally per day but may be higher in patients with refractory seizures and in patients requiring combination therapy. When OCBZ is substituted for ongoing CBZ therapy, it is possible to change the dosage immediately so that the patient finishes treatment with CBZ on one day and starts with a full dosage of OCBZ on the next day, even when the full dosage is 50% greater in milligrams than the corresponding CBZ dosage. Allergic skin reactions are rare, and crossreactivity is seen in about 25% of patients hypersensitive to CBZ. Hyponatremia after the use of OCBZ is usually benign, as long as the acute water intoxication is effectively treated. Because of its pharmacokinetic advantages and efficacy, we believe OCBZ is better than CBZ. We therefore consider OCBZ as the drug of first choice for conditions in which CBZ is currently indicated.

Pharmacokinetics of 10-OH-carbazepine, the main metabolite of the antiepileptic oxcarbazepine, from serum and saliva concentrations

ABSTRACT After administration of 600 mg of the antiepileptic oxcarbazepine to 7 healthy volunteers, serum and stimulated saliva samples were collected for the next 72 h. Concentrations of 10-OH-carbazepine, the main metabolite of oxcarbazepine, were determined by an HPLC method. The time-concentration curves showed a median Tmax of 8 h followed by a plateau until 24 h indicating saturable kinetic processes. Based on the curves, the pharmacokinetic parameters were calculated. The half-life of 10-OH-carbazepine in saliva, 13.8 ± 3.7 (SD) h, was significantly shorter than in serum, 19.3 ± 6.2 (SD) h. The half-life of 10-OH-carbazepine in serum was inversely correlated to the free fraction, estimated by the ratio saliva/serum concentrations. Calculation of the free fraction by this method showed that 53.1 ± 14.4 (SD) % of 10-OH-carbazepine is unbound in serum. There was a good correlation (r = 0.914) between serum and saliva concentrations of 10-OH-carbazepine from 8-72 h after administration of oxcarbazepine. This finding indicates that saliva concentrations may prove useful, as has been shown for carbamazepine, in therapeutic monitoring of oxcarbazepine treatment.

Pharmacokinetics of 10-OH-carbazepine, the main metabolite of the antiepileptic oxcarbazepine, from serum and saliva concentrations.

After administration of 600 mg of the antiepileptic oxcarbazepine to 7 healthy volunteers, serum and stimulated saliva samples were collected for the next 72 h. Concentrations of 10-OH-carbazepine, the main metabolite of oxcarbazepine, were determined by an HPLC method. The time-concentration curves showed a median Tmax of 8 h followed by a plateau until 24 h indicating saturable kinetic processes. Based on the curves, the pharmacokinetic parameters were calculated. The half-life of 10-OH-carbazepine in saliva, 13.8 +/- 3.7 (SD) h, was significantly shorter than in serum, 19.3 +/- 6.2 (SD) h. The half-life of 10-OH-carbazepine in serum was inversely correlated to the free fraction, estimated by the ratio saliva/serum concentrations. Calculation of free fraction by this method showed that 53.1 +/- 14.4 (SD) % of 10-OH-carbazepine is unbound in serum. There was a good correlation (r = 0.914) between serum and saliva concentrations of 10-OH-carbazepine from 8-72 h after administration of oxcarbazepine. This finding indicates that saliva concentrations may prove useful, as has been shown for carbamazepine, in therapeutic monitoring of oxcarbazepine treatment.