The Pharmacological Treatment of Pediatric Onset Idiopathic Generalized Epilepsies: The Therapeutic Effects of Topiramate, Lamotrigine, and Valproate / 대한간질학회지

ABSTRACT

PURPOSE: The majority of patients with idiopathic generalized epilepsy (IGE) are controlled by an antiepileptic drug when appropriately selected. So far, valproate is regarded as the first-line treatment for IGE. Also, it is postulated that lamotrigine and topiramate may have efficacy in IGE but there are a few evidence to support the usage. We examined the remission rates of seizures on valproate, lamotrigine, topiramate and factors predicting the outcome. METHODS: We reviewed the patients who diagnosed as IGE in pediatric neurology clinics in Asan Medical Center from March, 1995 to August, 2005. The patients with childhood absence epilepsy and patients without generalized spike and slow waves in EEG were excluded. Data were collected retrospectively on demographics, seizure types, antiepileptic drug treatment details, and remission rates. RESULTS: 64 of 80 patients had achieved one year period of remission by monotherapy with following drugs: Valproate (73.7% of 38 patients), lamotrigine (72.4% of 29 patients) or topiramate (83.3% of 18 patients). Among patients who failed to achieve remission by monotherapy, the combination of the drugs showed a remission rate of 72.7% (8/11 patients). Factors such as age, sex, family history, and history of febrile convulsions did not affect the remission rates. The existence of photoparoxysmal responses or focal epileptiform discharges, and syndrome diagnoses also couldn't be the predictive factors as well. CONCLUSIONS: As in adult patients with IGE, topiramate and lamotrigine as well as valproate can be used as the most effective anti-epileptic drugs in children with IGE without significant side effect.