Motor impairments in children with epilepsy treated with carbamazepine.

Nineteen children with epilepsy were tested on two occasions, first during treatment with carbamazepine (CBZ) and then 6 months later without treatment. Plasma drug concentrations were within the therapeutic limits in all children. The children were examined with a standardized test of gross- and fine- motor functions, the Bruininks-Oseretsky test of motor proficiency. Significant improvements were found in response speed (p < 0.05), in composite fine-motor tests (p < 0.01) and in the total test battery (p < 0.05) after the treatment had been withdrawn. A tendency to improvement was found in the fine-motor subtest of upper limb coordination (p = 0.08). Another group of 12 children was tested twice during treatment with CBZ with an interval of 6 months. No difference was found in this group except for an impairment of the results in the subtest of visual-motor control on the second test occasion (p = 0.05).

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.

PURPOSE: We wished to evaluate the prognostic usefulness of various EEG parameters with respect to remission rates after discontinuation of antiepileptic drug (AED) therapy in children treated for epileptic seizures. METHODS: Two hundred forty-four children with uncomplicated epileptic seizures were randomized to either 1 or 3 years of treatment with AEDs. The treatment was then discontinued in patients who had been seizure-free during the last 6 months of their allotted time of treatment (n = 154). After treatment discontinuation, the children were followed for at least 2 years. EEG recordings were performed before treatment was initiated and at regular intervals during treatment. RESULTS: The overall relapse rate was 37%. In many children, the amount of epileptiform activity varied considerably between subsequent recordings made during the treatment. The remission rate was slightly higher for children whose last recordings before AED discontinuation were free of epileptiform activity as compared with children in whom such activity was present. However, children who had irregular generalized spike-wave (SW) activity in the recordings made before discontinuation of treatment had a clearly higher relapse rate (67%) both as compared with children without epileptiform activity (33%) and as compared with children with other types of epileptiform activity (33%) in their last EEG recordings before discontinuation. All children treated for only 1 year whose final EEGs displayed generalized irregular SW activity relapsed. CONCLUSIONS: We conclude that the presence of epileptiform activity does not in itself necessarily influence prognosis after discontinuation of treatment but that certain types of such activity signal a high risk of relapse.

Comparison between one and three years of treatment in uncomplicated childhood epilepsy: a prospective study. I. Outcome in different seizure types.

PURPOSE: The main purpose of this prospective study was to analyze whether 1 year of treatment was as effective as 3 years with respect to remission rate in children with idiopathic epilepsy. METHODS: Treatment for epileptic seizures was started in 207 children aged 2-16 years. They were randomized to treatment for 1 or 3 years. At the end of the predetermined treatment period, 161 children had been seizure-free for 6 months and the treatment could be gradually withdrawn. RESULTS: The overall remission rate in our group of patients was significantly higher (71%) in the group treated for 3 years than in the group treated for 1 year (53%). However, comparison of remission rates between patients with different seizure types showed statistically significant differences in outcome depending on duration of treatment only in children with complex partial seizures (CPS). CONCLUSIONS: Our results show that 1 year of treatment can be recommended in children with benign partial epilepsy with rolandic spikes (BECT) and in children with simple partial seizures (SPS) but is clearly insufficient in children with CPS. A proper seizure classification is one important tool, although not sufficient, in offering recommendations concerning the duration of treatment in children with idiopathic epilepsy.

A general hospital population of childhood epilepsy.

In a general hospital population of 74,000 children under the age of 16 years in southern Stockholm, 79 children were started on antiepileptic drugs due to epilepsy during the 2 year period 1990-92. The mean annual incidence of childhood epilepsy in this area was 53 per 100,000 children younger than 16 years. Neurological impairments were identified in 35% of the children. The epilepsy diagnoses were set according to the International Classification System proposed by the International League Against Epilepsy. Partial seizures were seen in 52% of the children. The syndrome BECT was identified in 11%. The epilepsy was symptomatic in 30%, and therapy-resistant in 23%.

Valproate in the treatment of absence epilepsy in children: a study of dose-response relationships.

Seven children with absence epilepsy were treated with valproate (VPA). All but one child became free of absence seizures during VPA monotherapy. EEG was recorded for 24 h before start of VPA treatment and repeatedly during treatment. Correlation between plasma VPA concentration and reduction of the number of epileptic discharges was significant. Plasma concentration of 440-660 microM VPA was needed to achieve at least 50% reduction of seizure activity.

Concomitant regional odontodysplasia and hydrocephalus.

The case of a patient with concomitant regional odontodysplasia, hydrocephalus, and mental retardation is presented. Tooth eruption was retarded, probably because of the presence of a cementum-like substance on the enamel surface as well as the presence of discontinuous odontogenic epithelium that surrounded the affected teeth. Neural damage during intrauterine life is suggested as a likely cause of the dental abnormalities. This hypothesis is supported by the fact that both primary and permanent teeth in the area were affected. It is further supported by the finding of dysplastic dentin.

Oral health in non-institutionalized epileptic children with special reference to phenytoin medication.

The periodontal condition and caries experience was studied in non-institutionalized epileptic children (n = 55) who had not been subjected to any additional preventive measures. The children were distributed in a phenytoin (PHT) group with a mean age of 13.2 yr and a control group (mean age 11.8 yr) consisting of children treated with other anticonvulsants. The PHT group had a DF-s mean value of 5.4 in comparison to 7.2 in the control group. Determinations of gingival overgrowth based on the presence of gingival units with increased probing depth (greater than 4 mm) as well as the thickness of the marginal gingiva in buccolingual dimension measured on stone casts were performed. Although the plaque level and degree of gingival inflammation were similar in the two groups, 43% of the children in the PHT group showed one or more gingival units with increased probing depth (greater than 4 mm), but none in the control group. The thickness of the marginal gingiva was significantly (P less than 0.001) higher in the phenytoin-treated children compared to children who had never had phenytoin medication. In the PHT-group gingival overgrowth based on gingival units with increased probing depth was statistically significantly and positively associated with the variables gingivitis (P less than 0.05), visible plaque index (P less than 0.01), age (P less than 0.01) and years on PHT therapy (P less than 0.05).

Prenatal diagnosis of chondroectodermal dysplasia with fetoscopy.

Chondroectodermal dysplasia (Ellis-van Creveld syndrome) has previously been diagnosed prenatally only once, using fetoscopy. We report on two consecutive pregnancies in a woman at risk of having a child with the syndrome during which fetoscopic visualization was performed. Ellis-van Creveld syndrome was diagnosed prenatally in one instance, while it could be excluded in the other one. Non-invasive prenatal diagnosis of the syndrome is discussed.

Kinetics of clonazepam in relation to electroencephalographic and clinical effects.

The aim of this study was to see if the immediate EEG and clinical response to an intravenous dose of clonazepam was predictive for the effect of oral clonazepam maintenance therapy. Four children with petit mal epilepsy were given clonazepam intravenously during continuous EEG recording. Clonazepam plasma concentrations were determined repeatedly with a high performance liquid chromatographic method using a reversed phase system. The day after the intravenous dose the patients were given oral therapy with clonazepam. Repeated long-term EEG recordings were made and plasma concentrations of clonazepam were determined. There was no clinically satisfactory effect of clonazepam during oral maintenance treatment in three of the children who responded well to the intravenous dose of clonazepam. Thus, the immediate response to intravenous clonazepam was not a good predictor of the long-term effects in our patients.

A comparison between microcrystalline and conventional phenytoin preparations: relative bioavailability and steady-state plasma concentrations.

Plasma concentrations of two phenytoin products (a conventional phenytoin acid preparation and a microcrystalline form of phenytoin acid) were studied after single dose administration and during steady-state conditions in four healthy male volunteers. Relative bioavailability for the conventional tablet in comparison with the microcrystallin was in the range of 48-80% during single dose administration and in the range 54-95% at steady-rate. The microcrystalline preparation gave, as expected, a higher rate of absorption. During steady-state conditions, however, this higher rate of absorption was associated with considerable fluctuations in plamsa concentration during the dosage interval. The mean maximum plasma concentration was about 50% high than the value at the beginning of the dose interval (2-dose concentration value) when the microcrystalline product was administered. The corresponding figure was only about 25% for the conventional tablet. Since upward fluctuations in plasma concentrations may be associated with side effects, the more even level obtained with the conventional product may be an advantage from the clinical point of view. An incresed rate of bioavailability is not a clinical improvement if it occurs at the expense of greater fluctuations in plasma concentration during the dose interval.