Zonisamide Rufinamide<\/p>\n
PHENYTOINE PHENOBARBITAL<\/p>\n
How to choose AED?<\/strong><\/p>\n Secificity in children<\/p>\n <\/p>\n <\/p>\n AED and cognition<\/strong><\/p>\n Avoid<\/strong><\/p>\n VPA& CBZ: seem to have mild effects on atention and executive function<\/p>\n TPM: mood disorder, speech regression<\/p>\n <\/p>\n LVT: no data in children (sedative effects) LTG and OXC: no effect?<\/p>\n Define the epileptic syndrome<\/strong><\/p>\n A good EEG is better than repeated EEG<\/strong><\/p>\n \u00a0 Symptomatic and Cryptogenic epileptic sd in children and adolescent<\/strong><\/p>\n often chronic and refractory epilepsies effect on cognitive functions ++ polytherapy may be necessary absences or myoclonics: VPA, LTG generalised tonic-clonic seizures or partial seizures: most of AED are effective: PHT, CBZ, VPA, LTG, OXC, LVT, TPM.. Choose first an effective AED with no significant enzymatic induction, and with low rate of adverse effect Partial Symptomatic or cryptogenic epilepsies: \u201cFor initial monotherapy for complex partial seizures, carbamazepine and oxcarbazepine were treatments of choice, with valproate also first line.\u201d<\/p>\n Tretment of pediatric epilepsy: European expert opinion, 2007. Wheless et al. Epileptic Disord. 2007<\/p>\n \u00a0<\/strong><\/p>\n Surgery?<\/strong><\/p>\n Surgery must be early discussed if: Chronic Refractory epilepsy Focal seizures or secondary generalised seizures Focal lesion: focal resection, lobectomy<\/p>\n Rasmussen: Hemispherotomy not in generalised epilepsy: callosotomy<\/p>\n Mesio-Temporal Epilepsy<\/p>\n Febrile seizures \u2192 Temporal Epilepsy<\/p>\n Partial and complex partial seizures<\/strong><\/p>\n Normal neurological examination<\/p>\n Hipocampal sclerosis: MRI, SPECT, PET 90% refractory epilepsy<\/p>\n Surgical approach<\/strong><\/p>\n \u00a0<\/strong>13 years<\/p>\n Partial seizures<\/p>\n Gelastic seizures<\/p>\n Hyperphagia<\/p>\n <\/p>\n Vagal nerve stimulation<\/strong><\/p>\n \u00a0<\/strong>For non surgical refratory epilepsy Lennox-Gastaud sd<\/p>\n Dravet sd<\/p>\n Non surgical focal lesion<\/p>\n Plurifocal epilepsy<\/p>\n Refractory absences<\/p>\n Adverse effects:<\/p>\n Transitory Cough<\/p>\n Respiratory effect during sleep (Heberl\u00e9,<\/p>\n Berquin et al Epilepsia 2003)<\/p>\n <\/p>\n <\/p>\n Vagal nerve stimulation<\/strong><\/p>\n Steroids\u00a0<\/strong>(po, IV)<\/p>\n West<\/p>\n Lennox-Gastaut<\/p>\n Doose<\/p>\n Landu-Leffner<\/p>\n ESESS<\/p>\n Ketogenic diet<\/strong><\/p>\n Catastrophic epilepsy<\/p>\n Rasmussen hemispherotomy<\/p>\n IV Immunoglobulines? Plasmapheresis?<\/strong><\/p>\n \u00a0 Idiopathic generalised epilepsies in children and adolescent<\/strong><\/p>\n Childhood absence epilepsy<\/p>\n Epilepsy with myoclonic-absences<\/p>\n Juvenile Myoclonic Epilepsy<\/p>\n AED effective: sodium valproate, lamotrigine, ethosuximide, BZD add-on:\u00a0<\/strong>topiramate levetiracetam<\/p>\n Generalised epilepsy with only tonicclonic seizures<\/p>\n \u00b1 Carbamazepine, Oxcarbazepine<\/p>\n \u00a0<\/strong><\/p>\n Partial idiopathic epilepsy<\/strong><\/p>\n Benign epilepsy with Centro-Temporal Spikes:<\/p>\n BETCS (rolandic epilepsy)<\/strong><\/p>\n Valproate, Carbamazepine, Gabapentine,\u00a0Oxcarbazepine<\/strong>, Sulthiam<\/p>\n <\/p>\n Continuous Spikes and Waves during Slow<\/em><\/p>\n Sleep<\/em><\/p>\n May occur spontaneously<\/p>\n May be induced by AED<\/p>\n Carbamazepine ++, Gabapentine, Phenytoin, Valproate, Oxcarbazepine<\/p>\n <\/p>\n Oxcarbazepine and BECTS<\/strong><\/p>\n Long-term use of oxcarbazepine oral suspension in childhood epilepsy: open-label study (Rufo–Campos et a., J Child Neurol. 2006)<\/p>\n 62 patients (2 months \u2013 14 years old)<\/p>\n Coppola et al., Brain Dev. 2007<\/em><\/p>\n Levetiracetam\u00a0<\/strong>or\u00a0oxcarbazepine\u00a0<\/strong>as monotherapy in newly diagnosed benign epilepsy of childhood with centrotemporal spikes (BECTS).<\/p>\n Tzitiridou et al. Epilepsy Behav. 2005 70 children with BECTS 18 months follow-up<\/p>\n <\/p>\n Exacerbation during sleep Possible seizure exacerbation ?<\/strong><\/p>\n Oxcarbazepine and atypical evolution of benign idiopathic focal epilepsy of childhood.. Grosso et al., Eur J Neurol.2006 2 patients manifested atypical absences, neuropsychological disturbances, and generalized spike-and-wave discharges on EEGs that became continuous during sleep.<\/p>\n The third patient showed, during OXC therapy, more frequent partial motor seizures which ended with ictal vomiting and post-ictal obnubilation Vendrame et al., Epilepsiia 2007 (retrospective):<\/p>\n 12 patients\/290: worsening of preexisting seizures, new seizure types, and\/or EEG deterioration EEG: new onset of generalized epileptiform activity (not reported on the initial baseline EEG) Following substitution of OXC with a broad spectrum AED, significant improvement of seizure control and improvement in the EEG was observed. Myoclonic seizures 2 cases reported by Kaddurah & Holmes<\/p>\n <\/p>\n (2006 ) (16-year-old girl with 22q del, 23- month-old boy with global development delay)<\/p>\n 1 case reported by Hahn (2004) (negative myoclonusdrop atacks boy with partial symptomatic epilepsy) Chapman (2003) in idiopathic focal epilepsy of childhood Juvenile Myoclonic Epilepsy :Gelisse et al., Epilepsia 2004<\/p>\n \u00a0<\/strong><\/p>\n Experience in\u00a0<\/strong>Amiens<\/strong>\u00a0<\/strong><\/p>\n Exacerbation of myoclonic seizures in Juvenile Myclonic Epilepsy: N = 3<\/p>\n Define the epileptic syndrome first !!<\/strong><\/p>\n Exacerbation of myoclonic seizures in BECTS without CSWS: N = 1 Myoclonia and atypical absences in Atypical Benign Partial Epilepsy: N = 1<\/p>\n Less frequentt than with CBZ, TPM, VGB<\/strong><\/p>\n \u00a0<\/strong><\/p>\n Oxcarbazepine Initiation<\/strong><\/p>\n Oxcarbazepine:<\/p>\n <\/p>\n Oxcarbazepine is efective in monotherapy<\/strong><\/p>\n Partial and tonic clonic seizures ages 5 -18 years<\/p>\n \u00a0 \u00a0<\/strong>Trileptal and seizures in children. Open studies<\/strong><\/p>\n \u00a0<\/strong>Partial and generalised seizures N = 42 (> 4 years old) 6 months follow-up 87,5% seizure free<\/p>\n Serdaroglu et al. Pediatr Neurol. 2003<\/em><\/p>\n Partial seizures N=40 (30 months to 18 y)<\/p>\n Cryptog\u00e9n\u00e9tic: N= 18 or Symptomatic: N= 19<\/p>\n Lamaa, EEC , Madrid 2002,<\/em><\/p>\n Khotare Paediatr Neurol 2006)<\/em><\/p>\n \u00a0 Oxcarbazepine tolerability add-on ttherapy Hyponatremia<\/strong><\/p>\n Less frequent than in adults and usually mild (>125 mmol\/l) 75 children: Holtmann neuropediatrics 2002<\/p>\n Natremia < 135 mmol\/l: 26,6%<\/p>\n Hyponatremia < 125 mmol\/l: 2 children<\/p>\n Hyponatremia clinically significant: 1 child<\/p>\n 1\/24 children: Northam et al. Pediatr Neurol 2005<\/p>\n Hyponatremia =124 mmol\/l<\/p>\n Returned to normal after \u2193 OXC from 60 to 30 mg\/kg\/d<\/p>\n Experience in Amiens:<\/p>\n 2 temporary mild hyponatremia < 132 mmol\/l<\/p>\n 1 hyponatremia < 125 mmol\/l in an infant<\/p>\n (9 months) seizure free: discontinuing OXC, relapse seizures<\/p>\n \u00a0<\/strong><\/p>\n Global IQ and Cognitive functions<\/strong><\/p>\n No significant cognitive deficit with advised dose in adults<\/p>\n Open label study: 99 children, 6 to 17 old-year newly diagnosed partial seizures neuropsychological test batery<\/p>\n FePsy computerized battery<\/p>\n Rey auditory Verbal Learning Test<\/p>\n Raven\u2019s Progressive Matrice for children<\/p>\n OXC did not differ from CBZ or VPA<\/strong><\/p>\n \u00a0<\/strong><\/p>\n The cognitive effects of oxcarbazepine versus carbamazepine or valproate in newly diagnosed children with partial seizures<\/strong><\/p>\n Donati et al., Seizure. 2007<\/em><\/p>\n Computerized Visual Searching Task (CVST) 112 patients randomised, 99 completed the study<\/p>\n Mean CVST time decreased in all groups:<\/strong><\/p>\n <\/p>\n <\/p>\n Moyennes des TR sans et avec distracteur chez les enfants sains et \u00e9pileptiques<\/strong><\/p>\n Reaction times are impaired Trileptal, Cognitive functions and behaviour<\/p>\n Tzitiridou et al. Epilepsy& Behav 2005<\/em><\/p>\n 70 children with newly diagnosed BECTS WISC III, Illinois Test of Psychomottor Abilities, DSM-IV,, Bender-Santuci test<\/p>\n No impact on cognitive function when comparison was made<\/strong><\/p>\n with 45 matched healthy controls<\/p>\n with baseline (before treatment)<\/p>\n Epilepsy in infancy < 2 years generalised epileptic syndromes<\/strong><\/p>\n <\/p>\n Vigabatrin: 100-150 mg\/kg\/d<\/p>\n Steroids (hydrocortisone,ACTH)<\/p>\n Topiramate<\/p>\n Nitrazepam, Clobazam<\/p>\n Valproate ??<\/p>\n \u00a0<\/strong><\/p>\n Epilepsy in infancy < 2 years<\/strong><\/p>\n Short duration of treatment.<\/strong><\/p>\n When efficacy is quite similar always take in account\u00a0Tolerability\u00a0<\/strong>and\u00a0Safety<\/strong><\/p>\n \u00a0<\/strong><\/p>\n Trileptal efficacy in infants and young children:<\/strong><\/p>\n \u00a0 \u00a0<\/strong>OXC in monotherapy or adjunctive therapy<\/strong><\/p>\n 24 infants with Partial seizures 1 month to<4 years of age (> 3 kg)<\/p>\n Newly diagnosed or not controlled epilepsy<\/p>\n \u00a0 Experience in\u00a0<\/strong>Amiens<\/strong>\u00a0<\/strong><\/p>\n <\/p>\n <\/p>\n Follow-up: MRI normal, taylor dysplasia suspected<\/p>\n <\/p>\n Localisation de source par la m\u00e9thode de\u00a0Dipol Fit sur mod\u00e8le r\u00e9aliste<\/p>\n Maximilien<\/p>\n \u00a0 Probable spectrum of new AEDs in childhood epilepsies Summary<\/strong><\/p>\n Trileptal improves seizure control in children as young as 4 months and is equally effective whether added to carbamazepine or any other AEDs<\/p>\n Trileptal is safe and well tolerated in children Effective in non idiopathic epilepsies: in partial, tonic and tonic-clonic seizures not effective in absences and myoclonia Generalised Idiopathic epilepsy : rather not (absences, JME) Partial Idiopathic epilepsy (BECTS) : most often ffective but unfrequent worsening need to be aware<\/p>\n <\/p>\n Available antiepileptic drugs: Gabapentine Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Vigabatrin Felbamate Pregabalin Stiripentol Carbamazepine Valproate Future: Zonisamide Rufinamide PHENYTOINE PHENOBARBITAL How to choose AED? Secificity in children Epileptic syndromes are different than in adults Take in account changes due to physiological development and brain maturation abnormal cortical organisation and epileptogenesis: dysplasia, heterotopic neurons. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"footnotes":""},"categories":[377,376],"tags":[381],"class_list":["post-3066","post","type-post","status-publish","format-standard","hentry","category-numar-1-vol-2008","category-vol-2008","tag-patrick-berquin"],"_links":{"self":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3066","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/comments?post=3066"}],"version-history":[{"count":3,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3066\/revisions"}],"predecessor-version":[{"id":3093,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/posts\/3066\/revisions\/3093"}],"wp:attachment":[{"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/media?parent=3066"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/categories?post=3066"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/snpcar.ro\/en\/wp-json\/wp\/v2\/tags?post=3066"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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