PECULIARITIES OF THE FLOW OF EPILEPSY IN CHILDREN OF DIFFERENT AGE DEPENDING ON THE RECEIVED THERAPY
About the author:
Sukhonosova O. Yu.
Heading:
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Scentific article
Annotation:
Purpose: to analyze the efficiency of antiepileptic therapy in children of different age groups in longterm observation, depending on the prescribed antiepileptic drugs (AED) and to identify the factors affecting the course of epilepsy. Method. There were 1301 children under supervision aged from 1 year to 17 years with epilepsy divided into the following age groups: 1 month -1 year — 69 children (5%), 1-6 years — 262 children (20%), 6-14 years — 401 children (31%), 14-17 years — 569 children (44%). According to the form of epilepsy the patients were distributed as follows: symptomatic epilepsy – 793 children (61%), idiopathic epilepsy – 352 children (27%), cryptogenic epilepsy – 156 children (12%). A positive result is considered to be a remission and reduction of seizures more than 50% lasting more than 6 months, while a negative result is treatment failure (increase in number and severity of seizures, reduction of seizures to less than 50% and lack of therapeutic effect). Results. Patients included in our study received the following drugs: carbamazepine and oxcarbazepine (342 persons), valproate (315 persons), lamotrigine (96 persons), topiramate (322 persons), levetiracetam (226 persons).Prior to the study 807 patients were in monotherapy (62%), 468 patients were on 2 drugs (36%), 26 patients received 3 anticonvulsants (2%). In the treatment with carbamazepine and oxcarbazepine complete clinical remission was achieved in 151 patients (44%), in 191patients (56%) treatment had no effect. Upon receiving lamotrigine complete clinical remission was achieved in 51% of patients, in 49% patients there was no effect. Upon receipt of topiramate complete clinical remission was achieved in 197 patients (61%), 125 (39%) patients remained resistant to topiramate therapy. When treated with valproate 225 patients (71%) showed complete clinical remission, 90 patients (29%) were therapy resistant. In levetiracetam treatment clinical remission was achieved in 160 patients (71%), in 66 patients (29%) pharmacological resistance was observed. In 45% of patients who received two (39%) or more AED (6%), the efficiency of treatment was lower than in the monotherapy group. Clinical remission (with good drug tolerance and retention on therapy) was achieved in 27.5% of patients, reduction in the number of seizures to less than 50% was achieved in 28.9% of patients, lack of treatment effect was observed in 43.6% of patients. In duotherapy the most effective combinations were levetiracetam + valproate, topiramate + valproate. In polytherapy, the most effective combinations were oxcarbazepine + levetiracetam + valproate and levetiracetam + valproate +topiramate. Conclusion. The most effective medication in the age group 1-6 years were levetiracetam and valproate, in the age group 7-14 years – topiramate and valproate, in the age group 15-17 years — lamotrigine and levetiracetam. For the prognosis of the course and efficiency of therapy, the etiology of epilepsy and the age of debut are essential. Exogenous factors such as chronic persistent infections, traumatic brain injury, somatic and infectious diseases can worsen the course and reduce the efficiency of treatment.
Tags:
children, epilepsy, treatment efficacy.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 184-188 pages, index UDK 616.853-053:615.213-035