Skip to main content Accessibility help
×
Home

Seizure Exacerbation and Developmental Regression with Carbamazepine

  • A.N. Prasad (a1), M. Stefanelli (a2) (a3) and L Nagarajan

Abstract:

Background:

Unexpected exacerbation of seizures may occur following initiation of treatment with carbamazepine (CBZ). We reviewed the occurrence of such reactions in our patient population at a tertiary care children's hospital.

Methods:

A retrospective analysis of our clinic database identified 129/691 (18.6%) patients with epilepsy treated with CBZ, as monotherapy. 38/129 children were later switched to another drug. In 11/38 (28.5 %) clinical and/or EEG deterioration was observed. Two patients identified at another institution with similar exacerbation were also included in our analysis. We report on the findings in these 13 cases.

Results:

Two groups were identified: Group I - 6 patients with normal neurological exam, normal EEG background, and a diagnosis of idiopathic generalized epilepsy. Group II - 7 patients with an abnormal neurological exam and/or abnormal EEG background. Following introduction of CBZ therapy, worsening of preexisting seizures, appearance of new seizure types, behavioral regression, and accompanying EEG deterioration were reported in both groups. Dramatic improvement in seizure control occurred, following withdrawal of CBZ and substitution of another anticonvulsant.

Conclusion:

Physicians treating epilepsy must be aware that CBZ can exacerbate seizures, and cause developmental regression in children. Careful patient selection, when choosing CBZ as treatment, and prompt recognition of clinical deterioration and intervention, may help avoid or reverse these paradoxical reactions.

RÉSUMÉ: Introduction:

Une exacerbation inattendue des crises peut survenir suite au début du traitement avec la carbamazépine (CBZ). Nous avons examiné la fréquence de ces réactions chez notre population de patients dans un hôpital de soins tertiaires pour enfants.

Méthodes:

Une analyse rétrospective de la banque de données de notre clinique a identifié 129/691 (18.6%) patients épileptiques qui ont été traités par la CBZ en monothérapie. On y a substitué une autre médication chez 38/129 enfants. Chez 11/38 (28.5%), une détérioration clinique et/ou EEG a été observée. Deux patients ayant présen¬té une exacerbation similaire, identifiés dans une autre institution, sont également inclus dans notre analyse. Nous rap¬portons les observations chez ces 13 cas.

Résultats:

Deux groupes ont été identifiés: le groupe I - 6 patients ayant un examen neurologique normal, une activité de fond de l'EEG normale et un diagnostic d'épilepsie généralisée idiopathique. Le groupe 11-7 patients ayant un examen neurologique anormal et/ou une activité de fond de l'EEG anormale. Suite à l'introduction du traitement par la CBZ, une exacerbation des crises de même type, l'apparition de nouveaux types de crises, une régression comportementale et une détérioration concomitante de l'EEG ont été rap¬portées dans les deux groupes. Une amélioration dramatique dans le contrôle des crises a été observée suite à l'arrêt de la CBZ et à la substitution d'un autre anticonvulsivant.

Conclusion:

Les médecins qui traitent Pépilepsie doivent être avertis que la CBZ peut exacerber les crises et causer une régression développementale chez les enfants. Une sélection soigneuse des patients qui reçoivent la CBZ et une détection précoce de la détérioration clinique ainsi qu'une intervention précoce peuvent aider à éviter ou à contrer ces réactions paradoxales.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Seizure Exacerbation and Developmental Regression with Carbamazepine
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Seizure Exacerbation and Developmental Regression with Carbamazepine
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Seizure Exacerbation and Developmental Regression with Carbamazepine
      Available formats
      ×

Copyright

Corresponding author

Discipline of Pediatrics (Neurology), The Charles A. Janeway Child Health Centre, Memorial University of Newfoundland, Janeway Place, St. John's, Newfoundland, Canada A1A 1R8

References

Hide All
1. Levy, L, Fenichel, G. Diphenylhydantoin activated seizures. Neurology 1965; 15: 716722.
2. Vallarta, JM, Bell, DB, Reichert, A. Progressive encephalopathy due to chronic hydantoin intoxication. Am J Dis Child 1974; 128: 2734.
3. Wilder, BJ, Rangel, R. Carbamazepine efficacy in adults with partial and generalized tonic- clonic seizures. Epilepsia 1987; 28 Suppl 3: S25-S28.
4. Dodson, WE. Carbamazepine efficacy and utilization in children. Epilepsia 1987; 28 Suppl 3: S17-S24.
5. Shields, WD, Saslow, E. Myoclonic, atonic, and absence seizures following institution of carbamazepine therapy in children. Neurology 1983; 33: 14871489.
6. Snead, OC 3rd Hosey, LC. Exacerbation of seizures in children by carbamazepine. N Engl J Med 1985; 313: 916921.
7. Loiseau, P. Do antiepileptic drugs exacerbate seizures? Epilepsia 1998; 39: 24.
8. De Silva, M, Macardle, B, Mcgowan, M, et al. Randomised comparative monotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed childhood epilepsy. Lancet 1996; 347: 709713.
9. Johnsen, S, Tarby, T, Sidell, A. Carbamezepine induced seizures. Ann Neurol 1984; 16: 392393.
10. Liporace, JD, Sperling, MR, Dichter, MA. Absence seizures and carbamazepine in adults. Epilepsia 1994; 35: 10261028.
11. Horn, CS, Ater, SB, Hurst, DL. Carbamazepine-exacerbated epilepsy in children and adolescents. Pediatr Neurol 1986; 2: 340345.
12. Marescaux, C, Hirsch, E, Finck, S, et al. Landau-Kleffner syndrome: a pharmacologic study of five cases. Epilepsia 1990; 31: 768777.
13. So, EL, Ruggles, KH, Cascino, GD, Ahmann, PA, Weatherford, KW. Seizure exacerbation and status epilepticus related to carbamazepine-10,11-epoxide. Ann Neurol 1994; 35: 743746.
14. Sachdeo, R, Chokroverty, S. Enhancement of absence with Tegretol (Abstract). Epilepsia 1985; 26: 534.
15. Callahan, DJ, Noetzel, MJ. Prolonged absence status epilepticus associated with carbamazepine therapy, increased intracranial pressure, and transient MRI abnormalities. Neurology 1992; 42: 198201.
16. Silverstein, FS, Parrish, MA, Johnston, MV. Adverse behavioral reactions in children treated with carbamazepine (Tegretol). J Pediatr 1982; 101: 785787.
17. Marjerrison, G, Jedlicki, SM, Keogh, RP, Hrychuk, W, Poulakakis, GM. Carbamazepine: behavioral, anticonvulsant and EEG effects in chronically-hospitalized epileptics. Dis Nerv Syst 1968; 29: 133136.
18. Pryse-Phillips, WE, Jeavons, PM. Effect of carbamazepine (Tegretol) on the electroencephalograph and ward behaviour of patients with chronic epilepsy. Epilepsia 1970; 11: 263273.
19. Rodin, EA, Rim, CS, Rennick, PM. The effects of carbamazepine on patients with psychomotor epilepsy: results of a double-blind study. Epilepsia 1974; 15: 547561.
20. Jeavons, P. Carbamazepine and the EEG. In: Wink, C, ed. Tegretol in epilepsy: report of an international clinical symposium. Manchester: C. Nicholls, 1972: 3539.
21. Wilkus, R, Dodrill, C, Troupin, A. Carbamazepine and the electroencephalogram in epileptics: a double blind study in comparison to phenytoin. Epilepsia 1978; 19: 283291.
22. Talwar, D, Arora, MS, Sher, PK. EEG changes and seizure exacerbation in young children treated with carbamazepine. Epilepsia 1994; 35: 11541159.
23. Swinyard, E, Woodhead, J. Experimental detection, quantification and evaluation of anticonvulsants. In: Woodbury, D, Penry, J, Pippenger, C, eds. Antiepileptic Drugs. New York: Raven Press, 1982: 111126.
24. Snead, OC 3rd Basic mechanisms of generalized absence seizures. Ann Neurol 1995; 37: 146157.
25. Lortie, A, Chiron, C, Mumford, J, Dulac, O. The potential for increasing seizure frequency, relapse, and appearance of new seizure types with vigabatrin. Neurology 1993; 43: S24-S27.
26. Dhuna, A, Pascual-Leone, A, Talwar, D. Exacerbation of partial seizures and onset of nonepileptic myoclonus with carbamazepine. Epilepsia 1991; 32: 275278.
27. Sozuer, D, Atakli, D, Atay, T, Baybas, S, Arpaci, B. Evaluation of various antiepileptic drugs in juvenile myoclonic epilepsy. Epilepsia 1996; 37: 77.
28. Wakai, S, Ito, N, Sueoka, H, et al. Severe myoclonic epilepsy in infancy and carbamazepine [letter]. Eur J Pediatr 1996; 155: 724.
29. Viani, F, Romeo, A, Viri, M, et al. Seizure and EEG patterns in Angelman’s syndrome. J Child Neurol 1995; 10: 467471.

Seizure Exacerbation and Developmental Regression with Carbamazepine

  • A.N. Prasad (a1), M. Stefanelli (a2) (a3) and L Nagarajan

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed