DOI QR코드

DOI QR Code

Antiepileptic Drugs in Children : Current Concept

  • Lee, Jeehun (Department of Pediatrics, Samsung Medical Center, Sunkyunkwan University School of Medicine)
  • 투고 : 2019.04.19
  • 심사 : 2019.04.30
  • 발행 : 2019.05.01

초록

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.

키워드

참고문헌

  1. Aldenkamp AP, Alpherts WC, Sandstedt T, Blennow G, Elmqvist G, Heijbel J, et al. : Antiepileptic drug-related cognitive complaints in seizurefree children with epilepsy before and after drug discontinuation. Epilepsia 39 : 1070-1074, 1998 https://doi.org/10.1111/j.1528-1157.1998.tb01292.x
  2. Ambrosetto G, Tassinari CA : Antiepileptic drug treatment of benign childhood epilepsy with rolandic spikes: is it necessary? Epilepsia 31 : 802-805, 1990 https://doi.org/10.1111/j.1528-1157.1990.tb05522.x
  3. Andersson T, Braathen G, Persson A, Theorell K : A comparison between one and three years of treatment in uncomplicated childhood epilepsy: a prospective study. II. The EEG as predictor of outcome after withdrawal of treatment. Epilepsia 38 : 225-232, 1997 https://doi.org/10.1111/j.1528-1157.1997.tb01101.x
  4. Beghi E, Giussani G, Grosso S, Iudice A, La Neve A, Pisani F, et al. : Withdrawal of antiepileptic drugs: guidelines of the Italian League Against Epilepsy. Epilepsia 54 Suppl 7 : 2-12, 2013
  5. Berg AT, Shinnar S : Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology 44 : 601-608, 1994 https://doi.org/10.1212/WNL.44.4.601
  6. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B, et al. : Two-year remission and subsequent relapse in children with newly diagnosed epilepsy. Epilepsia 42 : 1553-1562, 2001 https://doi.org/10.1046/j.1528-1157.2001.21101.x
  7. Blumer D, Montouris G, Hermann B : Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci 7 : 445-456, 1995 https://doi.org/10.1176/jnp.7.4.445
  8. Braathen G, Andersson T, Gylje H, Melander H, Naglo AS, Noren L, et al. : Comparison between one and three years of treatment in uncomplicated childhood epilepsy: a prospective study. I. Outcome in different seizure types. Epilepsia 37 : 822-832, 1996 https://doi.org/10.1111/j.1528-1157.1996.tb00034.x
  9. Chong DJ, Bazil CW : Update on anticonvulsant drugs. Curr Neurol Neurosci Rep 10 : 308-318, 2010 https://doi.org/10.1007/s11910-010-0120-8
  10. Chong DJ, Lerman AM : Practice update: review of anticonvulsant therapy. Curr Neurol Neurosci Rep 16 : 39, 2016 https://doi.org/10.1007/s11910-016-0640-y
  11. Commission on Epidemiology and Prognosis, International League Against Epilepsy : Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia 34 : 592-596, 1993 https://doi.org/10.1111/j.1528-1157.1993.tb00433.x
  12. Delgado MR, Riela AR, Mills J, Pitt A, Browne R : Discontinuation of antiepileptic drug treatment after two seizure-free years in children with cerebral palsy. Pediatrics 97 : 192-197, 1996
  13. Dooley J, Gordon K, Camfield P, Camfield C, Smith E : Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study. Neurology 46 : 969-974, 1996 https://doi.org/10.1212/WNL.46.4.969
  14. Fegueux S, De Truchis P, Balloul H, Maslo C, Matheron S, Coulaud JP : Sulphadiazine desensitization in AIDS patients. AIDS 5 : 1275-1276, 1991 https://doi.org/10.1097/00002030-199110000-00028
  15. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. : ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55 : 475-482, 2014 https://doi.org/10.1111/epi.12550
  16. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. : Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46 : 470-472, 2005 https://doi.org/10.1111/j.0013-9580.2005.66104.x
  17. Freeman JM, Tibbles J, Camfield C, Camfield P : Benign epilepsy of childhood: a speculation and its ramifications. Pediatrics 79 : 864-868, 1987
  18. Halma E, de Louw AJ, Klinkenberg S, Aldenkamp AP, DM IJ, Majoie M : Behavioral side-effects of levetiracetam in children with epilepsy: a systematic review. Seizure 23 : 685-691, 2014 https://doi.org/10.1016/j.seizure.2014.06.004
  19. Hirsch LJ, Arif H, Nahm EA, Buchsbaum R, Resor SR Jr, Bazil CW : Crosssensitivity of skin rashes with antiepileptic drug use. Neurology 71 : 1527-1534, 2008 https://doi.org/10.1212/01.wnl.0000334295.50403.4c
  20. Hirtz D, Berg A, Bettis D, Camfield C, Camfield P, Crumrine P, et al. : Practice parameter: treatment of the child with a first unprovoked seizure: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 60 : 166-175, 2003 https://doi.org/10.1212/01.WNL.0000033622.27961.B6
  21. Holowach J, Thurston DL, O'Leary J : Prognosis in childhood epilepsy. Follow-up study of 148 cases in which therapy had been suspended after prolonged anticonvulsant control. N Engl J Med 286 : 169-174, 1972 https://doi.org/10.1056/NEJM197201272860401
  22. Jacoby A, Johnson A, Chadwick D : Psychosocial outcomes of antiepileptic drug discontinuation. The Medical Research Council AED Withdrawal Study Group. Epilepsia 33 : 1123-1131, 1992 https://doi.org/10.1111/j.1528-1157.1992.tb01769.x
  23. Kanner AM, Balabanov A : Depression and epilepsy: how closely related are they? Neurology 58(8 Suppl 5) : S27-S39, 2002 https://doi.org/10.1212/WNL.58.8_suppl_5.S27
  24. Klassen BD, Sadler RM : Induction of hypersensitivity to a previously tolerated antiepileptic drug by a second antiepileptic drug. Epilepsia 42 : 433-435, 2001 https://doi.org/10.1046/j.1528-1157.2001.33400.x
  25. Kuyucu S, Caubet JC : Hypersensitivity reactions to antiepileptic drugs in children: epidemiologic, pathogenetic, clinical, and diagnostic aspects. J Allergy Clin Immunol Pract 6 : 1879-1891.e1, 2018 https://doi.org/10.1016/j.jaip.2018.07.003
  26. Lee J, Park EG, Lee M, Lee J : Desensitization to oxcarbazepine: longterm efficacy and tolerability. J Clin Neurol 13 : 47-54, 2017 https://doi.org/10.3988/jcn.2017.13.1.47
  27. Mehta M, Shah J, Khakhkhar T, Shah R, Hemavathi KG : Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: case series. J Pharmacol Pharmacother 5 : 59-62, 2014 https://doi.org/10.4103/0976-500X.124428
  28. Panayiotopoulos CP, Obeid T, Tahan AR : Juvenile myoclonic epilepsy: a 5-year prospective study. Epilepsia 35 : 285-296, 1994 https://doi.org/10.1111/j.1528-1157.1994.tb02432.x
  29. Patsalos PN, Berry DJ, Bourgeois BF, Cloyd JC, Glauser TA, Johannessen SI, et al. : Antiepileptic drugs--best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 49 : 1239-1276, 2008 https://doi.org/10.1111/j.1528-1167.2008.01561.x
  30. Schmitz EB, Moriarty J, Costa DC, Ring HA, Ell PJ, Trimble MR : Psychiatric profiles and patterns of cerebral blood flow in focal epilepsy: interactions between depression, obsessionality, and perfusion related to the laterality of the epilepsy. J Neurol Neurosurg Psychiatry 6 2: 458-463, 1997 https://doi.org/10.1136/jnnp.62.5.458
  31. Shinnar S, Berg AT : Does antiepileptic drug therapy prevent the development of "chronic" epilepsy? Epilepsia 37 : 701-708, 1996 https://doi.org/10.1111/j.1528-1157.1996.tb00639.x
  32. Shinnar S, Berg AT, Moshe SL, Kang H, O'Dell C, Alemany M, et al. : Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol 35 : 534-545, 1994 https://doi.org/10.1002/ana.410350506
  33. Shinnar S, Berg AT, O'Dell C, Newstein D, Moshe SL, Hauser WA : Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure. Ann Neurol 48 : 140-147, 2000 https://doi.org/10.1002/1531-8249(200008)48:2<140::AID-ANA2>3.0.CO;2-Y
  34. Shinnar S, Vining EP, Mellits ED, D'Souza BJ, Holden K, Baumgardner RA, et al. : Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study. N Engl J Med 313 : 976-980, 1985 https://doi.org/10.1056/NEJM198510173131603
  35. Sillanpaa M, Jalava M, Kaleva O, Shinnar S : Long-term prognosis of seizures with onset in childhood. N Engl J Med 338 : 1715-1722, 1998 https://doi.org/10.1056/NEJM199806113382402
  36. Stroink H, Brouwer OF, Arts WF, Geerts AT, Peters AC, van Donselaar CA : The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood. J Neurol Neurosurg Psychiatry 64 : 595-600, 1998 https://doi.org/10.1136/jnnp.64.5.595
  37. Verrotti A, Morresi S, Basciani F, Cutarella R, Morgese G, Chiarelli F : Discontinuation of anticonvulsant therapy in children with partial epilepsy. Neurology 55 : 1393-1395, 2000 https://doi.org/10.1212/WNL.55.9.1393
  38. Vining EPG, Mellitis ED, Dorsen MM, Cataldo MF, Quaskey SA, Spielberg SP, et al. : Psychologic and behavioral effects of AEDs in children: a double-blind comparison between phenobarbital and valproic acid. Pediatrics 80 : 165-174, 1987

피인용 문헌

  1. Carbamazepine adversely altered the pituitary-testicular axis with resultant reproductive dysfunctions than levetiracetam or carbamazepine-levetiracetam adjuvant treatment in male Wistar rat vol.52, pp.11, 2019, https://doi.org/10.1111/and.13871
  2. Specifics of Metabolism in Children vol.34, pp.4, 2020, https://doi.org/10.36290/far.2020.027
  3. Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia : A prospective cohort study vol.100, pp.26, 2019, https://doi.org/10.1097/md.0000000000026478
  4. Effects of long-term antiepileptic therapy on carotid artery intima-media thickness vol.16, pp.2, 2019, https://doi.org/10.4103/jpn.jpn_84_20
  5. A Case of Carbamazepine-Induced Aggravation of Self-Limited Epilepsy with Centrotemporal Spikes Epilepsy and Valproate-Induced Hyperammonemic Encephalopathy in a Child with Heterozygous Gene Variant o vol.2021, 2021, https://doi.org/10.1155/2021/2362679
  6. Antiepileptic Drugs-Induced Enuresis in Children: An Overview vol.37, pp.2, 2021, https://doi.org/10.1177/8755122520964047
  7. Comparative assessment of health-related quality of life with and without anticonvulsant therapy in patients with childhood epilepsy with centrotemporal spikes vol.49, pp.8, 2019, https://doi.org/10.1177/03000605211039805