OBJECTIVE: To systematically evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) as second-line drugs for the treatment of convulsive status epilepticus (CSE) in children. METHODS: English and Chinese electronic databases were searched for the randomized controlled trials comparing the efficacy and safety of LEV and PHT as second-line drugs for the treatment of childhood CSE. RevMan 5.3 software was used for data analysis. RESULTS: Seven studies with 1 434 children were included. The Meta analysis showed that compared with the PHT group, the LEV group achieved a significantly higher control rate of CSE ( CONCLUSIONS LEV has a better clinical effect than PHT in the treatment of children with CSE and does not increase the incidence rate of adverse events.
Anticonvulsants/adverse effects* ; Child ; Humans ; Levetiracetam/therapeutic use* ; Pharmaceutical Preparations ; Phenytoin/adverse effects* ; Status Epilepticus/drug therapy*

OBJECTIVETo investigate the efficacy and safety of lamotrigine monotherapy in children with epilepsy via a systematic review.

METHODSPubMed, Cochrane, CNKI, VIP, CBM, Wanfang Data were searched for randomized controlled trials (RCTs) of lamotrigine monotherapy in children with epilepsy. Literature screening, data extraction, and quality assessment were performed according to the method recommended by Cochrane Collaboration. RevMan 5.2 software was used to conduct the Meta analysis.

RESULTSA total of 9 RCTs involving 1 016 participants were included. Lamotrigine yielded a significantly lower complete control rate of seizure than ethosuximide, but the complete control rate of seizure showed no significant differences between lamotrigine and carbamazepine/sodium valproate. Patients treated with lamotrigine had a significantly lower incidence rate of adverse events than those treated with carbamazepine, but the incidence rate of adverse events showed no significant differences between patients treated with lamotrigine and sodium valproate/carbamazepine. The drop-out rate showed no significant differences between the three treatment groups.

CONCLUSIONSLamotrigine is an ideal alternative drug for children who do not respond to traditional antiepileptic medication or experience significant adverse reactions; however, more high-quality RCTs with a large sample size and a long follow-up time are needed to confirm these conclusions.

Anticonvulsants ; therapeutic use ; Epilepsy ; drug therapy ; Humans ; Randomized Controlled Trials as Topic ; Triazines ; adverse effects ; therapeutic use

Lamotrigine is an anticonvulsant drug used to treat partial and generalized seizure disorders. Hypersensitivity to lamotrigine usually causes mild symptoms such as fever, rash, and slight invasion of internal organs. However, a 33-year-old male patient who was admitted with Stevens-Johnson syndrome after taking lamotrigine for 15 days experienced hepatic failure and died 5 days after admission. This case demonstrates the importance of realizing that lamotrigine can lead to fatal hepatic failure, and that tests for the normal liver function should be performed when administering lamotrigine.
Adult ; Alanine Transaminase/blood ; Anticonvulsants/*adverse effects/therapeutic use ; Aspartate Aminotransferases/blood ; Drug Hypersensitivity/complications/*diagnosis ; Humans ; Liver/enzymology/metabolism ; Liver Failure/*etiology ; Male ; Stevens-Johnson Syndrome/diagnosis/drug therapy ; Triazines/*adverse effects/therapeutic use

OBJECTIVETo evaluate the therapeutic effect and safety of rapamycin in treatment of children with tuberous sclerosis complex (TSC) complicated with epilepsy.

METHODThis was an open-label, prospective, self-controlled study. From Sep. 2011 to Sep. 2013, 52 patients with the diagnosis of tuberous sclerosis complicated with epilepsy receiving rapamycin treatment for at least 24 weeks were enrolled.

RESULTOf the 52 children, 34 were male and 18 female. The median age at onset of epilepsy was 4.8 months (4 days-49 months), the median age for treatment with rapamycin was 27 months (4.5-172.5 months). Ten children had a family history of TSC. In 24 children TSC gene detection was carried out, among whom TSC1 mutation was detected in 4 cases and TSC2 mutation in 20. Before rapamycin therapy, 59.62%, (31/52) patients took more than 3 antiepileptic drugs, of whom 10 cases even took more than 5 kinds of antiepileptic drugs. Fifty-two patients received rapamycin treatment for 24 weeks, seizure free rate was 25.00% (13 cases), the total effective rate was 73.08% (38 cases); 31 cases received treatment for 48 weeks, seizure free 6 cases, total effective 23 cases; 17 cases accepted treatment for 72 weeks, seizure free 5 cases, total effective 13 cases; 12 cases received treatment for 96 weeks, seizure free 3 cases, total effective 9 cases. With the decrease of seizure attacks, use of antiepileptic drug types were reduced simultaneously, they had a negative correlation. Before rapamycin therapy, the average frequency of seizures was 70.27 times/d, the number of antiepileptic drug kinds was 1.30. After 24, 48, 72, 96 weeks' treatment, the average seizure frequency was reduced to 1.94-2.80 times /d and the antiepileptic drugs were reduced to 0.83-0.97 kinds. On every visit during the follow-up, blood and urine routine tests, liver and kidney function test showed no abnormality in the 52 cases. The drug dosage was 1 mg/(m(2)×d), average 0.7 mg/d (0.35-1.20 mg/d). Blood concentrations of rapamycin remained below 10 µg/L (average 6.5 µg/L). The main side effect was oral ulcer which happened in 23.08% (12/52). The oral ulcer would disappeared 2-3 days later. 17.31% (9/52 cases) had upper respiratory infection.

CONCLUSIONRapamycin was effective in children with tuberous sclerosis and epilepsy with few adverse reactions. The daily dose of rapamycin for children patients is 1 mg/m(2), which has a certain effect on seizures and a good safety profile.

Adolescent ; Anticonvulsants ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Epilepsy ; complications ; drug therapy ; Female ; Humans ; Infant ; Male ; Prospective Studies ; Seizures ; prevention & control ; Sirolimus ; adverse effects ; therapeutic use ; Treatment Outcome ; Tuberous Sclerosis ; complications ; genetics

OBJECTIVETo investigate the clinical efficacy and safety of oxcarbazepine (OXC) suspension in children with focal epilepsy.

METHODSA total of 118 children aged 2-14 years, who were newly diagnosed with focal epilepsy between October 2009 and December 2011, were randomly divided into experimental group (n=60) and control group (n=58). The experimental group was treated with an orally suspension of OXC and the control group was orally administered with carbamazepine (CBZ) tablets. The two treatment regimens were compared in terms of clinical efficacy and safety.

RESULTSAfter 13 and 26 weeks of treatment, the experimental group had response rates of 75% and 72% respectively and seizure-free rates of 53% and 50%, and the control group had response rates of 71% and 66% and seizure-free rates of 50% and 43% respectively. There were no significant differences in the clinical efficacy between the two groups (P>0.05). After 26 weeks of treatment, the adverse event rates of the experimental and control groups were 18% and 40% respectively, with a significant difference between the two groups (P<0.05).

CONCLUSIONSOXC suspension has a comparable clinical efficacy to that of CBZ tablets in children aged 2-14 years who are newly diagnosed with focal epilepsy, but OXC suspension causes fewer adverse events and has higher safety.

Adolescent ; Anticonvulsants ; therapeutic use ; Carbamazepine ; adverse effects ; analogs & derivatives ; therapeutic use ; Child ; Child, Preschool ; Epilepsies, Partial ; drug therapy ; Female ; Humans ; Male ; Suspensions

The clinical characteristics of patients with seizures after allogeneic hematopoietic stem cell transplantation (allo-HSCT) were analyzed. A total of 8 cases of seizures after allo-HSCT were investigated. Clinical data of these cases were studied retrospectively. Of 159 cases subjected to allo-HSCT, seizure occurred in 8 cases during 29-760 days after transplantation, median survival time was 46 days, and there were 6 cases of tonic-clonic seizure. The incidence of seizure after matched unrelated HSCT was higher than that after related HSCT (P=0.017). Of 7 cases treated with cyclosporine A (CsA), 4 cases obtained high blood levels of CsA. In addition, hyponatremia was diagnosed in 5 cases. Abnormal electroencephalogram and brain MRI findings were found in some cases. During 20 days after seizure, 2 cases died due to infection and graft-versus-host disease (GVHD), respectively. It was suggested that multiple factors are associated with seizures after allo-HSCT. Rapid identification and correction of the causative factors are very important to prevent permanent central nervous system damage and reduce the mortality.
Adolescent ; Adult ; Anticonvulsants ; therapeutic use ; Fatal Outcome ; Female ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; adverse effects ; methods ; Humans ; Male ; Phenytoin ; therapeutic use ; Retrospective Studies ; Seizures ; diagnosis ; drug therapy ; etiology ; Transplantation, Homologous ; Treatment Outcome ; Valproic Acid ; therapeutic use ; Young Adult

No abstract available.
Aged ; Anti-Bacterial Agents/*adverse effects ; Anticonvulsants/therapeutic use ; Cephalosporins/*adverse effects ; Consciousness Disorders/diagnosis/drug therapy/*etiology ; Diabetic Nephropathies/complications/*therapy ; Electroencephalography ; Female ; Humans ; Pneumonia, Bacterial/complications/*drug therapy ; *Renal Dialysis ; Status Epilepticus/diagnosis/drug therapy/*etiology ; Treatment Outcome ; Uremia/therapy

OBJECTIVETo evaluate the efficacy and safety of slow anti-epileptic drug (AED) taper protocol and a rescue benzodiazepine protocol in video-electroencephalography (video-EEG) monitoring for presurgical evaluation of epilepsy.

METHODSSixty-two of 109 patients with refractory focal epilepsy underwent pre-surgical video-EEG monitoring with a slow AEDs taper protocol and a rescue benzodiazepine protocol. Seizures were recorded by video-EEG in 56 patients. The time to the first seizure, duration of monitoring, incidence of 4-h and 24-h seizure clustering, secondarily generalized tonic-clonic seizures (sGTCS), status epilepticus, falls and cardiac asystole were evaluated.

RESULTSA total of 191 seizures were recorded in the 56 cases, and the diagnostic efficiency of video-EEG was 90.3%. The mean time to the first seizure was 2.4 days and the time to conclude video-EEG monitoring averaged 6.8 days. Eight (12.9%) patients had 4-h clusters and 24 (38.7%) had 24-h clusters. Seizure clusters were more frequent in extra temporal epilepsy than in temporal lobe epilepsy. While 19 sGTCS were recorded in 15 patients (26.8%), status epilepticus did not occur and no seizure was complicated by cardiac asystole. Epileptic falls with no significant injuries occurred in 4 patients.

CONCLUSIONSeizure clustering is common during presurgical video-EEG monitoring, but serious adverse events are rare with a slow AED tapering and a rescue benzodiazepine protocols. These two protocols are effective and save in presurgical video-EEG monitoring for refractory focal epilepsy.

Adolescent ; Adult ; Anticonvulsants ; adverse effects ; therapeutic use ; Electroencephalography ; methods ; Epilepsy ; diagnosis ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Substance Withdrawal Syndrome ; diagnosis ; prevention & control ; Video Recording ; Young Adult

OBJECTIVEChildren with refractory epilepsy who suffered from severe liver function impairment during valproic acid (VPA) treatment at routine dosage were studied. The clinical manifestations and therapeutic approaches were investigated in order to improve its diagnosis and management.

METHODClinical information as well as features and management of 4 inpatients who were suffered from intractable epilepsy with severe liver function impairment induced by VPA since 2006 were collected and analyzed, including age of onset of epilepsy, VPA using age and the time when liver injury occurred, clinical manifestations, auxiliary examinations and management.

RESULTAmong the 4 cases, three were male and one was female. The admitted age ranged from 1 - 9 years and 1 month. The course of disease was 25 d - 6 months. They manifested as refractory epilepsy of epilepsia partialis continua which was difficult to control. After using VPA for 62 d (50 - 76 d), all developed severe impairment of liver synthetic function which was not related to the concentration of VPA. One was diagnosed with Alpers syndrome, two were suspicious of Alpers syndrome, and the other was diagnosed gliocytoma after brain biopsy. VPA was stopped immediately and symptomatic therapies were used. Other than that, intravenous injection of L-carnitine in 3 cases recovered the liver function.

CONCLUSIONVPA-associated severe hepatotoxicity can manifest first as impaired liver synthetic function. Besides alanin transaminase and aspartate transaminase, the liver synthetic function test is more important than monitoring of liver enzymatic functions in monitoring for the hepatotoxicity. Intravenous injection of L-carnitine in early stage showed good treatment effect.

Anticonvulsants ; adverse effects ; Biomarkers ; blood ; Carnitine ; administration & dosage ; therapeutic use ; Chemical and Drug Induced Liver Injury ; drug therapy ; etiology ; Child ; Child, Preschool ; DNA Mutational Analysis ; Diffuse Cerebral Sclerosis of Schilder ; chemically induced ; drug therapy ; genetics ; Epilepsy ; drug therapy ; Female ; Humans ; Infant ; Liver ; drug effects ; pathology ; Liver Function Tests ; Male ; Retrospective Studies ; Valproic Acid ; adverse effects

Anticonvulsants ; adverse effects ; therapeutic use ; Child ; Epilepsy ; drug therapy ; Humans