Abstracts

Rationale: Benign Epilepsy of Childhood with Centro-Temporal Spikes (BECCTS) is the most common childhood localization related epilepsy syndrome. Seizures are generally easy to treat. The most preferred antiepileptic drugs (AEDs) in BECCTS are Carbamazepine (CBZ) and Valproic Acid (VPA). There are a few case reports in which CBZ has resulted in seizure aggravation and or worsening EEG picture in BECCTS¹. Many neurologists prefer CBZ as the first line AED considering its better side effect profile compared to VPA. Objective: To identify children with BECCTS who had aggravation of seizures/EEG discharges due to AED. Methods: Inclusion criteria 1.Children below the age of 18 years 2.Electroclinical diagnosis of BECCTS as per ILAE criteria. Children treated in the pediatric neurology clinic at McMaster University during 2003- 2007 March, fulfilling the inclusion criteria were studied. Electroclinical worsening was defined as the occurrence of new seizure types, increasing number of seizures (by at least 50%) or EEG worsening (> 100% increase in the number of epileptiform discharges, evidence of extension of epileptiform discharges to other regions of brain, generalized epileptiform discharges or electrographic seizures; all compared to pretreatment EEG). AED was presumed to be the reason for electroclinical worsening as follows: definite; when the child met the clinical and EEG criteria and had documented improvement on stopping the AED of interest (AED-I) and, probable; when only the clinical or EEG criteria was met. Results: 39 children (M:F 19:20; age 3-11 years, mean 7.1) were included in the study. 28 children were treated with AED. The first line AEDs were CBZ (17), VPA (3), Oxcarbazepine (3), Clobazam (3), Lamotrigine (1) and, Phenytoin (1). At some point during therapy, 19 patients received CBZ (12 had seizure control, 63%) and 8 received VPA (6 had seizure control, 75%). We identified 5 children who had electroclinical worsening due to AED. The details are mentioned in table 1. Two children (# 1, 2) had definite electroclinical worsening due to CBZ and OXC. Three children had probable electroclinical worsening due to CBZ. Patient 1 presented as non-convulsive status epilepticus. Three patients subsequently became seizure free on VPA.Conclusions: CBZ was the most preferred AED in this series. Though effective in controlling seizures in the majority (63%), electroclinical worsening was not uncommon in the CBZ treated group (4/19; 21%). VPA did not induce electroclinical worsening in this series and showed similar efficacy in controlling seizures. Before increasing the dose of CBZ for poor seizure control, we suggest an EEG to look for electrographic worsening of epileptiform discharges. A large prospective study is needed to examine the effectiveness of alternative AEDs in BECCTS to avoid electroclinical worsening and to identify the potential characteristics that might predict unfavourable response to CBZ. Reference 1. Corda D et al.Incidence of drug-induced aggravation in benign epilepsy with centrotemporal spikes. Epilepsia 2001; 42:754-9.