Abstracts

RATIONALE: Carbamazepine (CBZ) may worsen absence and myoclonic seizures. Many clinicians are therefore reluctant to administer CBZ to patients with generalized tonic-clonic seizures (GTCS) in the setting of idiopathic generalized epilepsy, for fear of exacerbating or precipitating these seizure types, even though CBZ is clearly effective against GTCS. We report three patients with idiopathic generalized epilepsy for whom CBZ was superior to other anti-epileptic drugs (AEDs) in controlling GTCS.
METHODS: Chart review of 3 patients, selected from approximately 30 patients referred for inclusion in a genetic study of idiopathic generalized epilepsy.
RESULTS: Patients included a 38F with random GTCS, a 40M with GTCS on awakening, and a 22M with juvenile absence epilepsy. Two patients had second-degree relatives with epilepsy. EEGs in all showed generalized spike-wave discharges at [gte]3Hz, and variable focal features. Other AEDs that were ineffective against GTCS, or that produced unacceptable adverse effects, included phenytoin (rash in 2 patients), phenobarbital, valproate, felbamate (stopped because of leukopenia later revealed to be due to indolent leukemia), methsuximide, primidone, gabapentin, acetazolamide, lorazepam, and lamotrigine (rash in 1). Patients have been free of GTCS for 3-5 years on CBZ monotherapy, CBZ with primidone, or CBZ in various combinations aimed at treating refractory absence seizures.
CONCLUSIONS: Though relatively contraindicated in patients with generalized absence or myoclonic seizures, in selected individuals with idiopathic generalized epilepsy, CBZ can be superior to other AEDs against GTCS. It is an important alternative in patients with generalized epilepsies whose GTCS do not respond to [dsquote]broad spectrum[dsquote] AEDs.