Antiepileptic drugs in pediatric epilepsy

Ravat, Sangeeta; Gupta, Rohit

doi:10.4103/1817-1745.40585

Cited by 5 publications

(5 citation statements)

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“…This finding showed that serum level has poor correlation with occurrence of adverse drug reactions. This observation is supported by other studies [2,11].…”

Section: Discussionsupporting

confidence: 91%

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Does steady state serum level of Valproic acid correlate with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy?

Noureen

Rana²,

Sattar

et al. 2015

J Pediatr Neurol

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Epilepsy is a heterogeneous disorder and its treatment is often complicated by variable drug response. Antiepileptic properties of Valproic acid were discovered in 1963 and since then it is widely used for treatment of epilepsy. The objective of this study was to explore the correlation of steady state serum level of Valproic acid with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy. This prospective analytical study was conducted in the Neurology Department-The Children Hospital and The Institute of Child Health Multan, Pakistan from March 2009 to February 2010. Sixty children between one to 14 years of age taking Valproic acid for treatment of epilepsy, for more than 3 months as monotherapy were included. Age, sex, dose of Valproic acid, type of seizure, response of seizure with treatment and any side effect of drug were noted. Trough Valproic acid serum level was measured by Latex Enhanced Immunoturbidometric Method by Randox VPA 1?Series Kit according to manufacturer instructions. Chi square test was used to measure the relationship of serum level with dose, seizure response and frequency of adverse drug reactions. P value of less than 0.05 was considered as significant. Our results showed that male female ratio was 1.1:1. Mean age was 7.3 ? 3.9 yr. Mean dose of Valproic acid was 32.4 ? 11.3 mg/kg/day. Generalized tonic clonic seizures were noted in 50% of patients, complex partial in 16.7%, myoclonic in 15%, absence seizures in 5% and mixed type of seizures was noted in 8.3% of patients. Complete seizure response was noted in 60% of patients, partial response in 18.3% and no response in 21.7% of patients. Serum level of 50?100 ?g/mL (therapeutic) was noted in 38.30% of patients, below 50 ?g/mL (subtherapeutic) in 46.8% and above 100 ?g/mL (supratherapeutic) in 14.9% of patients. Serum level below 50 ?g/mL was noted in 60.7% of children with complete seizure response while 50?100 ?g/mL was noted in 21.7% of children with no response. Adverse drug reactions were noted in 66.6% of patients in this study. These adverse reactions were noted in 64.2% of children with serum level below 50 ?g/mL, 65.2% with 50?100 ?g/mL and 77.7% with serum level above 100 ?g/mL. No correlation of Valproic acid serum level was noted with dose (P value 0.546), seizure response (P value 0.998) and frequency of adverse drug reactions (P value 0.743) in this study. No significant correlation of Valproic acid serum level was noted with dose, seizure response and frequency of majority of adverse drug reactions.

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“…This finding showed that serum level has poor correlation with occurrence of adverse drug reactions. This observation is supported by other studies [2,11].…”

Section: Discussionsupporting

confidence: 91%

“…Epilepsy is a heterogeneous disorder and its treatment is often complicated by variable drug response [1]. The management of epilepsy has been greatly influenced and enhanced by introduction of rapid and reproducible drug assay [2,3].…”

Section: Introductionmentioning

confidence: 99%

Does steady state serum level of Valproic acid correlate with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy?

Noureen

Rana²,

Sattar

et al. 2015

J Pediatr Neurol

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“…Seizures are known to affect personality and may affect the study. 10 Positive family history of seizure was found in 16% of patients. It is reported that epilepsy is a hereditary disorder family history and genetic predisposition lead to increased risk of epilepsy in child.…”

Section: Discussionmentioning

confidence: 99%

Drug utilization pattern of antiseizure drugs and their adverse effects in the pediatric population, in a tertiary care hospital attached to a medical college

Mistry

Solanki

Prajapati

et al. 2014

Int J Basic Clin Pharmacol

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Background: Epilepsy is "a condition characterized by recurrent (two or more) seizure, unprovoked by any immediate identifi ed cause." The desired outcome of antiseizure drug (ASD) therapy is to be seizure-free throughout the rest of life. The objective was to study the utilization pattern and adverse drug reactions (ADRs) associated with the use of ASDs in pediatric outpatients in epilepsy clinic. Methods: This cross-sectional, observational and single center study was carried out over a period of 1 year in 430 pediatric patients. Analyzed data included demographic details and drugs prescribed in respective seizure types along with ADRs due to ASDs. Results: In a total 430 patients analyzed, seizure were most commonly observed in boys (69.8%) in 6-10 year of age (45.3%), with a positive family history in (16%), with no specifi c cause of seizure in (71.6%), with most common type was focal seizure in (62.3%), which was mainly treated with carbamazepine (73.8%). Most common ADR was irritability (32.2%) with Valproate being main drug. 87.3% ADRs were in " possible" as per World Health Organization causality assessment scale, 94.9% ADRs were "mild" as per Hartwig and Siegel severity assessment scale and 98.3% ADRs were "preventable" as per Schumock and Thornton preventability scale. Conclusion: Focal seizure was most common type of seizure observed mainly in boys of 6-10 year with carbamazepine as mainly prescribed drug. Use of appropriate ASDs in the majority of patients as per guidelines, has decreased number of ADRs in our study. Prescribing drugs were mainly from essential drug list and by generic names.

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“…If the specific patient's optimal levels are unknown, reasonable target levels are at the upper end of the usual therapeutic ranges (Table 4). 21,22 Intravenous loading can be performed with phenobarbital, phenytoin/fosphenytoin, valproate, or levetiracetam.…”

Section: Evaluation Of a Patient With Epilepsy Who Presents With A Break Through Seizurementioning

confidence: 99%

Approach to an adult with an episode of seizure

Kajaria¹,

Cherian

2022

IJN

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A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.

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Antiepileptic drugs in pediatric epilepsy

Cited by 5 publications

References 0 publications

Does steady state serum level of Valproic acid correlate with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy?

Does steady state serum level of Valproic acid correlate with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy?

Drug utilization pattern of antiseizure drugs and their adverse effects in the pediatric population, in a tertiary care hospital attached to a medical college

Approach to an adult with an episode of seizure

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