Abstracts

RATIONALE: To quantitatively evaluate changes of seizure phenomena under acute withdrawal of carbamazepine(CBZ)and valproic acid(VPA) with therapeutic intensive seizure analysis(TISA). METHODS:13 patients with pharmacoresistant partial seizures were studied under video-EEG combined TISA with complete CBZ or VPA withdrawal within 3-4 days. Monitoring phases included AEDs withdrawal and AEDs-free phases according to serum concentration. Duration(lasting seconds of each seizure and semiology), intensity(0-4 grade), N/24h (numbers of attacks per 24 hours) and D/24h (seconds per 24 hours occupied by attacks) of seizures and semiology were recorded. Exact Wilcoxon test was employed for statistic analysis. RESULTS: Totally 160 seizures of 6 patients of CBZ group and 49 seizures of patients of VPA group were analyzed with observation course 818.92h and 1249.05h respectively. In AED-free phase, compared with AED-withdrawal phase, CBZ group showed no obvious changes in the general duration and intensity(P>0.05), but obvious increase of N/24h and of D/24h (both P<0.05); also the N/24h and D/24h of complex body movements; VPA group had obvious increase of general intensity(P<0.05), also intensity of hand move(P<0.05), D/24h of vocalization (P<0.05).More sever dystonia were observed in VPA. Symptoms as oro-alimentary automatisms, fumbling showed no difference between groups and phases. Only difference between these two groups were the general intensity and duration(both P<0.05). CONCLUSIONS: The general withdrawal symptoms of CBZ was more sever than that of VPA in this study with TISA analysis. Both of the AEDs withdrawal influence the propagation of seizure activity. Only TISA method can elucidate these idiographic differences.