Comparison of lamotrigine and oxcarbazepine monotherapy for pediatric focal epilepsy: An observational study

Abstract

Purpose: Oxcarbazepine is known as an effective first-line monotherapy for pediatric focal epilepsy. Lamotrigine has also been reported to have similar efficacy to and better tolerability than carbamazepine. Therefore, the effectiveness of oxcarbazepine and lamotrigine monotherapies was compared in patients with pediatric focal epilepsy.

Method: A total of 116 patients in pediatric patients with partial epilepsy received lamotrigine (n = 43) or oxcarbazepine (n = 73) monotherapy. The clinical characteristics, seizure outcomes, reasons for drug discontinuation, retention rate and adverse effects were evaluated for each drug.

Results: Oxcarbazepine was more commonly used than lamotrigine (69/73 vs. 23/43) as initial monotherapy. Lamotrigine showed better efficacy than oxcarbazepine in terms of the seizure outcome more than 12 months (P<0.05). Oxcarbazepine and lamotrigine showed similar tolerability in terms of the retention rate, drug discontinuation and adverse effects. The rates of successful discontinuation were similar for patients receiving these drug as initial monotherapy (P > 0.05). The seizure outcome was much better for lamotrigine than for oxcarbazepine in patients with normal MRI findings and normal development (P = 0.001, P = 0.01). The retention rate was high in patients with MRI abnormalities or developmental delay in the lamotrigine group. The choice of lamotrigine was the only independent variable that predicted a seizure-free state, even after correcting for clinical variables (OR = 4.80, P = 0.013).

Conclusions: Lamotrigine was superior to oxcarbazepine monotherapy because of its greater effectiveness in treating pediatric focal epilepsy. Lamotrigine can be selected as a first-line monotherapy in patients with or without abnormal MRI findings or delayed development.

Keywords: Lamotrigine; Oxcarbazepine; Partial epilepsy.