儿童癫痫指南
Carbamazepine
It is the drug of first choice for all newly diagnosedpartial epilepsies(53), after the age of 2 years. Thedose varies between 10-30 mg/kg in the form of twicea day dosing and preferably given as slow releasepreparations(54,55), if syrups are used they should begiven three times a day. Carbamazepine may induceor exacerbate generalized seizures like infantilespasms, myoclonic, tonic and absence seizures in theyounger child(56). Paradoxically, it may exacerbatepartial seizures as well, in benign partial epilepsies. Itmay worsen the EEG with deterioration in cognition,behavior and language & can rarely precipitateelectrical status in slow wave sleep (ESES)(57).Parents should be informed about the common sideeffects like appearance of new seizures, deteriorationof school performance or appearance of rash(Steven’s) Johnson’s and Drug Rash Eosinophilia andSystemic Symptoms- DRESS syndrome shared withphenytoin and pheno-barbitone) which should bereported immediately. A routine hematologicalmonitoring is not recommended.11. Newer Antiepileptic Drugs
Table I summarizes the guidelines for newantiepileptic drugs. Table II depicts the dosage andside-effects of common antiepileptic drugs.Clobazam
It can be used as intermittent therapy(57,58) or ascontinuous add-on drug(59-61); is not recommendedas monotherapy for newly diagnosed epilepsy. Intermittent use
(a)Febrile seizure prophylaxis to prevent acuteseizure recurrence(57,58).(b)Reflex epilepsy e.g. hot water epilepsy (justbefore a hot water bath).(c)Catamenial epilepsy (Straddling the menstrualperiod).(d)During seizure clusters. Add-on therapy
(a)Refractory partial(59) and generalizedepilepsies(60,61).(b)Certain epileptic syndromes like LGS,Myoclonic-astatic epilepsy (Doose’s syndrome),Dravet’s syndrome, Continuous spike and wavein slow wave sleep (CSWS).The starting dose is 0.1-0.25 mg/kg, which istitrated against seizure control every seven days till0.75 mg/kg- 1mg/kg is reached. It should be given intwo divided doses or as a single nightly dose; itshould be withdrawn very gradually to avoidwithdrawal seizures. Tolerance may not be asignificant problem(62).
Common adverse events to be recognized includebehaviour changes (aggression, hyperactivity), sleepdisturbances, constipation and weight gain.Oxcarbazepine
Can be used as monotherapy in newly diagnosedpartial epilepsy for children above 4 years ofage(63), if affordable and available. It can be usedfor add-on therapy in refractory partial andsecondary generalized epilepsy(64,65). Start with adose of 10 mg/kg; titrated upwards weekly, guidedby seizure control, to a maximum of 40 mg/kg.Though once daily preparations are marketed, it isprudent to give this drug in two divided doses. Anabrupt switchover from CBZ to OXZ can be done ina dose ratio of 2:3(66). No routine monitoring ofdrug levels, blood counts or sodium isrecommended, unless symptomatic (vomiting,drowsiness or increased seizures).Lamotrigine
Monotherapy in newly diagnosed generalizedepilepsy (absence and myoclonic)(67) and in otherpartial(68)/generalized epilepsies, and in specificepilepsy syndromes like idiopathic generalizedepilepsy in teenage years, especially girls (as firstchoice)(29). Occasionally, myoclonic jerks maybeparadoxically worsened by lamotrigine, especially inJME.
Add-on in refractory generalized epilepsieslike absence, tonic and tonic-clonic and syndromeslike LGS and in refractory partial epilepsiesalso(64).