儿童癫痫指南
IAP EXPERT COMMITTEE GUIDELINESDIAGNOSIS AND MANGEMENT OF EPILEPSY
TABLE I. GUIDELINE FOR NEW DRUGS IN NEW ONSET AND REFRACTORY EPILEPSYClobazam
New OnsetPartialAbsenceMyoclonicGTCRefractoryPartialAbsenceMyoclonicSpasmLGS
YesYesYesNoYes
YesYesYesYesYes
YesYesYesNoPossible
YesYesYesYesYes
YesNoNoNoNo
YesNoNoNoNo
No
LamotrigineYes (JME, CAE)
YesYesYesYes
Levateracetam
No
Topiramate
No
OxcarbazepineYes (Partial )
YesNoNoNo
TiagabineNo
TABLE II DOSES AND SIDE EFFECTS OF COMMON ANTIEPILEPTIC DrugsPhenobarbitonePhenytoinValparinCarbamazepineOxcarbazepineLamotrigineClobazamTopiramateLevateracetamTiagabine
Daily dose3-8 mg/kg5-15 mg/kg10-60 mg/kg10-30 mg/kg20-45 mg/kg0.2- 15 mg/kg0.4-1.2 mg/kg 3-9 mg/kg15-45 mg/kg0.5-2 mg/kg
Common side effects
Hyperactivity, academic deterioration, reversal of sleep cycles
Poor seizure control due to fluctuating drug levels, cosmetic side effects,hirsutism, ataxia
Nausea, vomiting, loss of appetite, weight gain, irregular menstruation, alopecia,somnolence
Drug rash, worsening seizures, rarely worsening school performanceSomnolence, vomiting (hyponatremia), seizure exacerbationDrug rash, Steven-Johnson syndrome
Behaviour changes, aggression, sleep disturbances, constipation, weight gainCognitive/language deterioration, fever, acidosis in infancyBehaviour changes
Somnolence, Seizure exacerbation
The dose should initially be 0.5 mg/kg (alone),0.2 mg/kg (with VPA), and 0.6 mg/kg (withphenobarbitone, phenytoin, carbamazepine); itshould be doubled every 2 weeks to a maximum of15mg/kg (alone) and 5mg/kg/day (with VPA) andhigher when used with enzyme inducers. LTG has tobe titrated slowly to prevent rashes and StevensJohnson syndrome.Topiramate
It can be used as a second line add-on agent inrefractory partial and generalized epilepsies as wellas Lennox Gastaut syndrome(64). It maybeparticularly useful in certain syndromes like infantilespasms(69,70) and Dravet’s syndrome(71). Atpresent, its use as first line monotherapy in newlydiagnosed epilepsy is not recommended because of asignificant adverse effect profile.
It should be started at a dose of 0.5-1 mg/kg in biddoses, escalated weekly or biweekly, upto maximumof 5-10mg/kg (72); Higher doses (10-30 mg/kg) andrapid escalation (every 3 days) are considered inspecial situations (infantile spasms, statusepilepticus); however, there could be a higherincidence of adverse events with high doses.