Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy
Keywords:
epilepsy, child, monotherapy, effect
Abstract
Background Problems on epilepsy do not only depend on thedisease itself but also on management and drug regimens. Drug
selection is very important to yield optimal treatment effect and
to prevent side effects due to long-term therapy.
Objective To determine whether there are any different effects
of monotherapy of phenytoin, carbamazapine, and valproic acid
on pediatric general tonic clonic and partial epilepsy.
Methods We conducted a historical cohort study on one month
until 18-years old children diagnosed as general tonic clonic or
parsial epilepsy treated with phenytoin, carbamazapine, or valproic
acid routinely for more than two years in Sardjito Hospital from
January 2000 until May 2007. The sample size of each group was
41. The main outcome was the time of 12-month remission,
whereas the secondary outcomes were withdrawal from treatment,
time to remission, side effects and cure rates.
Results Valproic acid increased the possibility to achieve 12-month
remission (RR 2.66; 95%CI 1.06;6.65) compared to phenytoin,
whereas carbamazapine did not (RR 1.47; 95%CI 0.66;3.28).
Survival analysis showed that valproic acid was better than
carbamazapine (P=0.042) and phenytoin (P=0.007). There were
no significant differences among groups in the result of withdrawal
from treatment, time to remission, and cure variables. The side
effects of valproic acid seemed less than those of others.
Conclusions Valproic acid increases the possibility of 12-month
remission compared to carbamazapine and phenytoin as
monotherapy in pediatric general tonic clonic and partial epilepsy
without increasing side effects. Carbamazapine has similar effects
of therapy to phenytoin.
References
1. Cowan LD, Bodensteiner JB, Leviton A, Doherty L.
Prevalence of epilepsy in children and adolescent. Epilepsia
1998;30:94-106.
2. Kurtz Z, Tookey P, Ross E. Epilepsy in young people: 23 year
follow up of British national child development study. BMJ
1998;316:339-42.
3. Annegers JF. The epidemiology of epilepsy. In: Wyllie E,
ed. The Treatment of Epilepsy: Principles and Practice. 2nd
ed. Baltimore, Md: Williams & Wilkins; 1996:165-172.
4. World Health Organization. Epilepsy: aetiology,
epidemiology and prognosis. In WHO Fact sheet no.165.
Geneva:2001.
5. Holdsworrth J, Whitmore K. A study of children with epilepsy
attending normal schools. Dev Med Child Neurol 1974;
196:746-65.
6. Stores G. School children with epilepsy at risk for learning and
behavioural problem. Dev Med Child Neurol 1978; 20:502-8.
7. Sadjimin T, Harjanto B, Sunartini, Indira LG. Frekwensi
gangguan perilaku pada epilepsi anak di RSUP Dr. Sardjito
Yogyakarta. Jurnal Epidemiologi Indonesia 1999;3:17-20.
8. Scambler G. Sosial aspects of epilepsy. In: Hopkins A, editor.
Epilepsy. London: Chapman and Hall; 1987. p. 497-510.
9. Tudur S, Marson AG, Williamson PR. Phenytoin versus
valproate monotherapy for partial onset seizures and
generalized onset tonic-clonic seizures. The Cochrane
Database of Systematic Reviews 2001, Issue 4.
10. Lazuardi S. Pengobatan epilepsy. In: Soetomenggolo, TS, Ismael,
S, editors. Neurologi anak. 2 nd ed. Jakarta: IDAI; 2000. p. 225-7.
11. Arzimanoglu A. Aicardi’s epilepsy in children. 3 rd ed.
Philadelphia: Lippincott Williams & Wilkins; 2004. p. 363-86.
12. Ko DY. Tonic clonic seizure. Available from: url: http://
www.emedicine.com.
13. Benbadis SR. Parsial epilepsy. Available from: url: http://
www.emedicine.com.
14. De Silva M, MacArdle B, McGowan M, Hughes E, Stewart
J, Neville BG, et al. Randomized comparative monotherapy
trial of phenobarbitone, phenytoin, carbamazapinee, or
sodium valproate for newly diagnosed childhood epilepsy.
Lancet 1996;347:709-13.
15. Madiyono B, Moeslichan S, Sastroasmoro S, Budiman I,
Purwanto SH. Perkiraan besar sampel. In: Sastroasmoro S,
Ismael S, editors. Dasar-dasar Metodologi Penelitian Klinis.
2 nd ed. Jakarta: Sagung Seto; 2000. p. 258-87.
16. Marson AG, Williamson PR, Hutton JL, Clough HE, Chadwick
DW. Carbamazapinee versus valproate monotherapy for epilepsy.
The Cochrane Database of Systematic Reviews 2000, Issue 3.
17. Tudur S, Marson AG, Clough HE, Williamson PR.
Carbamazapinee versus phenytoin monotherapy for
epilepsy. The Cochrane Database of Systematic Reviews
2002, Issue 2.
18. Verity CM, Hosking G, Easter DJ. A multicentre comparative
trial of sodium valproate and carbamazapinee in paediatric
epilepsy. The Paediatric EPITEG Collaborative Group. Dev
Med Child Neurol 1995;37:97-108.
19. Camfield C, Camfield P, Gordon K, Smith B, Dooley J.
Outcome of Childhood Epilepsy: A Population-Based Study
with A Simple Predictive Scoring System for Those Treated
with Medication. J Pediatrics 1993;122:861-8.
Prevalence of epilepsy in children and adolescent. Epilepsia
1998;30:94-106.
2. Kurtz Z, Tookey P, Ross E. Epilepsy in young people: 23 year
follow up of British national child development study. BMJ
1998;316:339-42.
3. Annegers JF. The epidemiology of epilepsy. In: Wyllie E,
ed. The Treatment of Epilepsy: Principles and Practice. 2nd
ed. Baltimore, Md: Williams & Wilkins; 1996:165-172.
4. World Health Organization. Epilepsy: aetiology,
epidemiology and prognosis. In WHO Fact sheet no.165.
Geneva:2001.
5. Holdsworrth J, Whitmore K. A study of children with epilepsy
attending normal schools. Dev Med Child Neurol 1974;
196:746-65.
6. Stores G. School children with epilepsy at risk for learning and
behavioural problem. Dev Med Child Neurol 1978; 20:502-8.
7. Sadjimin T, Harjanto B, Sunartini, Indira LG. Frekwensi
gangguan perilaku pada epilepsi anak di RSUP Dr. Sardjito
Yogyakarta. Jurnal Epidemiologi Indonesia 1999;3:17-20.
8. Scambler G. Sosial aspects of epilepsy. In: Hopkins A, editor.
Epilepsy. London: Chapman and Hall; 1987. p. 497-510.
9. Tudur S, Marson AG, Williamson PR. Phenytoin versus
valproate monotherapy for partial onset seizures and
generalized onset tonic-clonic seizures. The Cochrane
Database of Systematic Reviews 2001, Issue 4.
10. Lazuardi S. Pengobatan epilepsy. In: Soetomenggolo, TS, Ismael,
S, editors. Neurologi anak. 2 nd ed. Jakarta: IDAI; 2000. p. 225-7.
11. Arzimanoglu A. Aicardi’s epilepsy in children. 3 rd ed.
Philadelphia: Lippincott Williams & Wilkins; 2004. p. 363-86.
12. Ko DY. Tonic clonic seizure. Available from: url: http://
www.emedicine.com.
13. Benbadis SR. Parsial epilepsy. Available from: url: http://
www.emedicine.com.
14. De Silva M, MacArdle B, McGowan M, Hughes E, Stewart
J, Neville BG, et al. Randomized comparative monotherapy
trial of phenobarbitone, phenytoin, carbamazapinee, or
sodium valproate for newly diagnosed childhood epilepsy.
Lancet 1996;347:709-13.
15. Madiyono B, Moeslichan S, Sastroasmoro S, Budiman I,
Purwanto SH. Perkiraan besar sampel. In: Sastroasmoro S,
Ismael S, editors. Dasar-dasar Metodologi Penelitian Klinis.
2 nd ed. Jakarta: Sagung Seto; 2000. p. 258-87.
16. Marson AG, Williamson PR, Hutton JL, Clough HE, Chadwick
DW. Carbamazapinee versus valproate monotherapy for epilepsy.
The Cochrane Database of Systematic Reviews 2000, Issue 3.
17. Tudur S, Marson AG, Clough HE, Williamson PR.
Carbamazapinee versus phenytoin monotherapy for
epilepsy. The Cochrane Database of Systematic Reviews
2002, Issue 2.
18. Verity CM, Hosking G, Easter DJ. A multicentre comparative
trial of sodium valproate and carbamazapinee in paediatric
epilepsy. The Paediatric EPITEG Collaborative Group. Dev
Med Child Neurol 1995;37:97-108.
19. Camfield C, Camfield P, Gordon K, Smith B, Dooley J.
Outcome of Childhood Epilepsy: A Population-Based Study
with A Simple Predictive Scoring System for Those Treated
with Medication. J Pediatrics 1993;122:861-8.
Published
2008-02-29
How to Cite
1.
Nugroho M, Herini E, Sunartini S. Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy. PI [Internet]. 29Feb.2008 [cited 23Dec.2024];48(1):37-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/464
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-09-05
Accepted 2016-09-05
Published 2008-02-29
Accepted 2016-09-05
Published 2008-02-29
