Antiepileptic Drugs in Children : Current Concept

Abstract

An epileptic seizure is defined as the transient occurrence of signs and/or symptoms due to abnormally excessive or synchronous neuronal activity in the brain. The type of seizure is defined by the mode of onset and termination, clinical manifestation, and by the abnormal enhanced synchrony. If seizures recur, that state is defined as epilepsy. Antiepileptic drugs (AEDs) are the mainstay of treatment. Knowledge about initiating and maintaining adequate AEDs is beneficial for the clinician who treats children with epilepsy. This article will delineate the general principles for selecting, introducing, and discontinuing AEDs and outline guidelines for monitoring adverse effects. In general, AED therapy following a first unprovoked seizure in children is not recommended. However, treatment should be considered after a second seizure. In children and adolescents, if they are seizure-free for at least 2 years, attempts to withdraw medication/s should be made, taking into account the risks vs. benefits for the individual patient. The decision on when and what AED to use should be tailored according to the patient. For optimal treatment, the selection of adequate AEDs can be achieved by considering the precise definition of the patient’s seizure and epilepsy syndrome. Continuous monitoring of both therapeutic and adverse effects is critical for successful treatment with AEDs.

Comparative assessment of health-related quality of life with and without anticonvulsant therapy in patients with childhood epilepsy with centrotemporal spikes

“…Our study findings also suggest that ASM treatment in CECTS does not affect the ultimate prognosis, as previously known. 1,6 ASM therapy should be evaluated in terms of its role of reducing seizures, preventing the evolution to atypical forms, or reducing possible negative cognitive consequences associated with epileptiform activity 11 versus the risk of side effects and impact on quality of life.…”

“…8–10 Therefore, side effects and familial views should be considered before initiation of pharmacotherapy. 2,11…”

“…12 Nevertheless, there is a relationship between epilepsy stigma and impaired health-related quality of life (HRQOL). 11,13 Additionally, recent sources of literature emphasize that age-dependent focal epilepsies can coexist with an underlying brain lesion, causing motor impairments such as cerebral palsy (CP). 14,15 Thus, some children with CP should not be excluded from CECTS treatment approaches and directed instead to clinical pathways with more aggressive and prolonged therapy for “symptomatic epilepsy”.…”

Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia

“…[ 12 ] The incidence of side effect is extremely higher in the pediatric population because of several changes in pharmacokinetic parameters and pharmacodynamic responses occur with maturation throughout childhood. [ 13 , 14 ] Similar effects can be induced by slower rates of liver metabolism in neonate and higher activity of hepatic microsomal enzymes in children especially between 2–4 years of age due to relatively larger liver size in comparison to total body weight which requires higher maintenance doses compared to adults. [ 15 ] These adverse effects were found to be more pronounced among patients on old AEDs compared to their counterparts on new AEDs.…”

Carbamazepine adversely altered the pituitary–testicular axis with resultant reproductive dysfunctions than levetiracetam or carbamazepine–levetiracetam adjuvant treatment in male Wistar rat

“…Antiepileptic drugs, including CBZ, are often required for long‐term management of this neurological condition (Hanaya & Arita, 2016). However, prolonged AED administration is reportedly associated with a diverse adverse effect such as behavioural/psychiatric disorders (Lee, 2019), metabolic disruption (St Louis, 2009), hepatotoxicity (Ayalew & Muche, 2018), and alterations in bone turnover markers (Arora et al., 2016) to mention but a few. Moreover, sexual dysfunction and reproductive disorders are more common among patients with epilepsy than any typical population (Atif et al., 2016; Isojärvi, 2008; Luef, 2010; Wu et al., 2018), while there are consistent pieces of evidence on the adverse effect of some AEDs particularly on the testicular dysfunction (Akinsomisoye et al., 2017; Osuntokun et al., 2017), deregulation of sex hormones (Herzog et al., 2017), reproductive toxicity (Bairy et al., 2010; Karaduman et al., 2019), and reduction of seminal quality (Falokun et al., 2010).…”