Talwar D, Arora M S, Sher P K
Department of Neurology, University of Minnesota, Minneapolis.
Epilepsia. 1994 Nov-Dec;35(6):1154-9. doi: 10.1111/j.1528-1157.1994.tb01782.x.
Carbamazepine (CBZ) has been reported to exacerbate some seizure types in children. We studied the correlation between CBZ-associated EEG changes and seizure exacerbation in 59 children aged < 6 years treated with CBZ. All patients had EEGs before and after initiation of treatment; initial EEGs were not significantly different among the patients. In 33 children (56%), the subsequent EEGs were either unchanged or improved or demonstrated minor changes (Group I), and excellent to complete seizure control was achieved in 67% of patients. In 26 children (44%), the EEG became significantly more abnormal and was characterized predominantly by new appearance of generalized spike/polyspike-and-wave discharges (group II). The majority of these patients (65%) experienced seizure exacerbation (p < 0.001). For group I, symptomatic partial epilepsy, idiopathic focal epilepsy, and complex febrile seizures were significantly more common; in group II, cryptogenic seizure disorders were more common (p < 0.005). Children in group I were more likely to remain on CBZ or to be weaned from medication after successful treatment, whereas children in group II required additional medication(s) or complete discontinuation of CBZ. Our results suggest that new appearance of generalized paroxysmal discharges after treatment is highly correlated with seizure exacerbation or suboptimal control as well as with adverse outcome. Conversely, absence of significant EEG deterioration on CBZ is usually associated with good seizure control.
据报道，卡马西平（CBZ）会使儿童的某些癫痫发作类型加重。我们研究了59名接受CBZ治疗的6岁以下儿童中CBZ相关脑电图变化与癫痫发作加重之间的相关性。所有患者在治疗开始前后均进行了脑电图检查；患者之间的初始脑电图无显著差异。33名儿童（56%）随后的脑电图无变化、有所改善或仅有轻微变化（第一组），67%的患者癫痫发作得到了良好至完全控制。26名儿童（44%）的脑电图明显变得更加异常，主要表现为新出现的全身性棘波/多棘波和慢波放电（第二组）。这些患者中的大多数（65%）癫痫发作加重（p<0.001）。对于第一组，症状性部分性癫痫、特发性局灶性癫痫和复杂性热性惊厥更为常见；在第二组中，隐源性癫痫障碍更为常见（p<0.005）。第一组的儿童在成功治疗后更有可能继续使用CBZ或逐渐停药，而第二组的儿童需要加用其他药物或完全停用CBZ。我们的结果表明，治疗后全身性阵发性放电的新出现与癫痫发作加重或控制不佳以及不良预后高度相关。相反，使用CBZ后脑电图无明显恶化通常与癫痫发作得到良好控制有关。
