Oxcarbazepine and atypical evolution of benign idiopathic focal epilepsy of childhood

Abstract

Patients that have benign epilepsy with centrotemporal spikes (BECTS) may occasionally experience an atypical development in their course when treated with drugs such as carbamazepine. Three patients with electroclinical patterns consistent with BECTS showed seizure exacerbation during oxacarbazepine (OXC) therapy. Two manifested atypical absences, neuropsychological disturbances, and generalized spike-and-wave discharges in their electroencephalograms (EEGs) that became continuous during sleep. The third patient showed, during OXC therapy, more frequent partial motor seizures which ended with ictal vomiting and post-ictal obnubilation. EEGs recorded during sleep showed discontinuous paroxysmal activity in the right centrotemporal area. Symptoms were reversed following discontinuation of the OXC therapy. Although electroclinical findings were consistent with a BECTS diagnosis, all patients had some atypical features. Our observations show that BECTS patients, in particular those presenting with atypical findings, might be at risk for developing paradoxical reactions to OXC therapy. We suggest that OXC should be included in the list of drugs that may cause electroclinical deterioration in these patients.

Prospective study on long-term treatment with oxcarbazepine in pediatric epilepsy

“…OXC is already known to exacerbate EEG abnormalities and other recent studies have reported this characteristic [11,27], which was not recorded in our study. The final evaluation regards 24/36 patients, as nine were NR, one showed adverse effect and two exited at the beginning of the study.…”

Encephalopathy with status epilepticus during sleep (ESES) induced by oxcarbazepine in idiopathic focal epilepsy in childhood

“…In addition, worsening of an ongoing ESES has also been reported (Caraballo et al, 2013). De novo appearance of ESES following the introduction of OXC was observed by Grosso et al (2006) in two out of three children with atypical BECTS. In these two children, OXC provoked an increase in seizure frequency, the appearance of new seizure types, and the extreme activation of EEG epileptic abnormalities during sleep, as in ESES.…”

“…However, some reports have shown that OXC may aggravate seizures and worsen the EEG picture in children with idiopathic focal epilepsies of childhood (IFEC), including BECTS (Chapman et al, 2003;Grosso et al, 2006;Vendrame et al, 2007). Neuropsychological deterioration and exaggeration of EEG epileptic discharges during sleep, as seen in ESES, have been described following the introduction of OXC in only two children with atypical IFEC (Grosso et al, 2006). In this report we describe an additional patient in whom treatment with OXC induced ESES.…”

“…ESES disappeared after OXC withdrawal and treatment with valproate. At variance with the cases reported by Grosso et al (2006) Recording parameters: speed=20 mm/s; sensitivity=150 μV/cm; filter=70-1.6 Hz; electrode positions according to Nuwer MR et al (1998).…”

“…Oxcarbazepine (OXC) is a new AED that has been shown to be effective and well tolerated for the treatment of children with focal epilepsies, particularly benign epilepsy of childhood with centrotemporal spikes (BECTS) (Coppola et al, 2007). However, some reports have shown that OXC may aggravate seizures and worsen the EEG picture in children with idiopathic focal epilepsies of childhood (IFEC), including BECTS (Chapman et al, 2003;Grosso et al, 2006;Vendrame et al, 2007). Neuropsychological deterioration and exaggeration of EEG epileptic discharges during sleep, as seen in ESES, have been described following the introduction of OXC in only two children with atypical IFEC (Grosso et al, 2006).…”