[Comparative efficacy of carbamazepine, valproic acid and topiramate in symptomatic and cryptogenic frontal lobe epilepsy in children]

Abstract

For a retrospective observational investigation based on real clinical practice of relative efficacy of valpoic acid (VPA), carbamazepine (CBZ) and topiramate (TPM) we have selected 277 patients with seizure onset before 17 years with a undoubted diagnosis of symptomatic or cryptogenic frontal lobe epilepsy (FLE), who had received treatment according to ILAE recommendations, and observation time since the last treatment change was from 2 to 10 years. Patients suspicious for idiopathic epilepsies were excluded. The groups of patient receiving CBZ, VPA and TPM did not differ significantly in presenting unfavorable prognostic factors that allowed conducting direct comparison of efficacy of the investigated drugs. Efficacy of VPA in children with FLE was higher compared with CBZ (56% vs 22%, p<0,01) and TPM (56% vs 10%, p<0,001). CBZ and TPM caused seizure aggravation rather frequently, but no aggravation was noted while VPA treatment (14% and 17% respectively vs 0%, p<0,001). In case of presence of clinico-electroencephalografic and MRI signs of significant organic brain damage and seizure onset after 1 year of age VPA was most effective and TPM showed minimal effect. TPM was ineffective in case of focal cortical dysphasia and cerebral atrophy; in other lesions its efficacy was comparable with CBZ. In MRI-negative cases VPA was most effective (71% vs 24% for CBZ, p<0,001 and 20% for TPM, p<0,001). Efficacy of VPA, CBZ and TPM does not change with the number of previously used antiepileptic drugs (AEDs). VPA was also most effective as a first AED (63% vs 26%, for CBZ, p<0,001 and 13%, p<0,001 for TPM), as well as a second AED (50% vs 30% for CBZ and 7% for TPM, p<0,05). Adverse effects were more frequent during treatment with CBZ and TPM, than VPA (20% vs 6%, p<0,001 and 31% vs 6%, p<0,05, respectively).