A Retrospective Review of Efficacy and Tolerability of Carbamazepine in Children with Focal and Generalized Epilepsy: A Single Center Experience
Authors: Tadros Sara Nabil , Hussein Rasha Hussein Aly , Halim Michael Nabil 
Published: November 2024

Background

Epilepsy has usually been defined as ≥ 2 unprovoked seizures separated by at least 24 hours. This definition is based on the concept that the recurrence risk after two unprovoked seizures is about 80%, while the recurrence risk after a single unprovoked seizure is only about 50%.

Aim of the Work

to retrospectively evaluate the efficacy and tolerability of carbamazepine as monotherapy and as adjunctive therapy in treatment of children with focal and generalized epilepsies respectively, and how it compares to other drugs.

Patients and Methods

Records of 100 pediatric patients with epilepsy who were 16 years old or less & received carbamazepine treatment or derivative (Group A) and 100 pediatric patients with epilepsy who did not receive carbamazepine treatment or derivative (Group B) (total equal to 200 patients). Both Groups A and B were be further subdivided into 3 subgroups:

(1) patients with focal epilepsy on monotherapy (A1) with 9 patients & (B1) with 11 patients.

(2) patients with focal epilepsy on polytherapy (A2) with 27 patients & (B2) with 9 patients. (3) patients with generalized epilepsy on polytherapy (A3) with 64 patients & (B3) with 80 patients.

The following data were collected from patients’ records (detailed history regarding neonatal history, family history, detailed history of AED, detailed history of epilepsy including GASE scale (The Global Assessment of Severity of Epilepsy (GASE), aspects of the scale were rated on a 7-point Likert scale with descriptors for 1 representing “none or never” and 7 representing “extremely frequent, severe or high”

Comparison regarding efficacy and tolerability was done as below:

Within each subgroup of Group A: before and after CBZ use.

Between each subgroup of Group A and Group B. i.e

A1 VS B1

A2 VS B2

A3VS B3

It included the below items :

1. Efficacy Assessment:

Subjective/Clinical: Control of seizures – partial or complete expressed as a percentage from the baseline before adding the specific drug.

And by detecting seizure frequency difference (by subtracting seizure frequency after treatment from this before treatment)

Objective

GASE score before and after treatment..

Results

2. Tolerability : detected by noticing different side effects of all AED administrated and whether it was severe enough to stop the drug. 1. Both groups with focal monotherapy (A1 & B1) showed improvement regarding frequency of seizures when comparing each group with itself before & after treatment (p value 0.011 & 0.0003 respectively), however, comparison between both groups showed statistically significant result regarding final GASE severity score difference with much improvement in group A1 (p value 0.044) 2. Both groups with generalized seizures (A3 & B3) showed significant GASE severity score and seizure frequency improvement when comparing before and after treatment per each group (p value in group A3 &lt;0.001 & &lt;0.001 respectively & p value in group B3 &lt;0.001 & &lt;0.001 respectively). However, comparing the results of both groups together showed statistically significant results regarding seizure frequency difference with better results in the group B3 (p value &lt;0.001). 3. Regarding groups (A2 &B2); Comparing before and after treatment in group A2 showed significant GASE severity score improvement (p value 0.000) while comparing before and after treatment in the group B2 showed significant seizure frequency improvement (p value 0.018). However, comparison between both groups showed statistically significant results regarding seizure frequency difference with better improvement in the group B2 (P value &lt;0.001).

Conclusion

carbamazepine and its derivatives had superior efficacy as monotherapy for treating focal convulsions than other AEDs; on the other hand it had inferior efficacy as polytherapy in treating children with generalized convulsions.