Adjunctive therapy with oxcarbazepine in children with partial seizures

Glauser, Tracy A.; Nigro, Michael A.; Sachdeo, Rǎjesh C.; Pasteris, L A; Weinstein, Steven L.; Abou-Khalil, B.; Frank, L. Matthew; Grinspan, Augusto; Guarino, T; Bettis, David; Kerrigan, John F.; Geoffroy, G.; Mandelbaum, David E.; Jacobs, Tom; Mesenbrink, Peter; Kramer, Lynn D.; D’Souza, Joseph

doi:10.1212/wnl.54.12.2237

Cited by 170 publications

(143 citation statements)

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“…There is one study with class I evidence that evaluated the efficacy of oxcarbazepine in 267 children, aged 3 to 17 years, in a double-blind placebo controlled study. 72 The maximal doses of oxcarbazepine ranged between 30 and 46 mg/kg/day. A 50% responder rate of 41% was found among children on oxcarbazepine and 22% of children on placebo.…”

Section: Treatment Of Refractory Epilepsy In Children Question 4: Whmentioning

confidence: 99%

Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [RETIRED]

et al. 2004

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Abstract-Objective:To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide) in the treatment of children and adults with refractory partial and generalized epilepsies. Methods: A 23-member committee including general neurologists, pediatric neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review including MEDLINE, Current Contents, and Cochrane library for relevant articles from 1987 until March 2003. Results: All of the new AEDs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults. Gabapentin can be effective for the treatment of mixed seizure disorders, and gabapentin, lamotrigine, oxcarbazepine, and topiramate for the treatment of refractory partial seizures in children. Limited evidence suggests that lamotrigine and topiramate are also effective for adjunctive treatment of idiopathic generalized epilepsy in adults and children, as well as treatment of the Lennox Gastaut syndrome. Conclusions: The choice of AED depends upon seizure and/or syndrome type, patient age, concomitant medications, AED tolerability, safety, and efficacy. The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with refractory epilepsy and identify those seizure types and syndromes where more evidence is necessary.

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Section: Treatment Of Refractory Epilepsy In Children Question 4: Whmentioning

confidence: 99%

Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [RETIRED]

et al. 2004

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“…20 The study by Glauser included children between the ages of three and seventeen years with simple or complex crises of partial or generalized type, in accordance with the classification of the International League Against Epilepsy (1981 and 1989), which were not adequately controlled using one or two antiepileptic drugs concomitantly. 21 Patients who fulfilled the inclusion criteria were randomly distributed to receive oxcarbazepine 30 to 46 mg/kg or placebo. The outcomes analyzed were: incidence of seizure-free patients, dropout due to adverse events, incidence of adverse events and adverse events classified as serious.…”

Section: -18mentioning

confidence: 99%

“…The follow-up period was 112 days. 21 The study by Reinikainen included adult epilepsy patients with an unsatisfactory response to phenytoin or patients who had presented undesirable effects with this drug. The patients were randomized to receive oxcarbazepine 200 mg, increasing gradually to 800 mg; or carbamazepine 300 mg, increasing to 1,200 mg.…”

Section: -18mentioning

confidence: 99%

Oxcarbazepine for refractory epilepsy: systematic review of the literature

et al. 2009

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CONTEXT AND OBJECTIVE: It has been estimated that 50 million people worldwide suffer from epilepsy and around 30% will not achieve adequate control over the disease. The aim was to evaluate the effectiveness of oxcarbazepine for refractory partial or generalized epilepsy.METHODS: Systematic review. A search was conducted in the PubMed, Lilacs, EMBASE and CENTRAL databases. Studies were analyzed using the Cochrane Collaboration methodology. RESULTS:Four randomized clinical trials of medium to poor methodological quality were included. Among the adult patients, the chances that they would obtain a 50% reduction in seizure frequency were greater after using oxcarbazepine at doses of 600 mg (relative risk, RR 2.11; 95% confidence interval, CI 1.32 to 3.35), 1,200 mg (RR 3.24; 95% CI 2.11 to 4.98) and 2,400 mg (RR 3.83; 95% CI 2.59 to 5.97). Among the children, the response in the group using oxcarbazepine was also greater (RR 2.11; 95% CI 1.32 to 3.35). The oxcarbazepine doses of 1,200 mg (RR 17.59; 95% CI 2.37 to 130.35) and 2,400 mg (RR 25.41; 95% CI 6.26 to 103.10) were effective for keeping patients probably free from seizures, but the dose of 600 mg was not. There was no significant difference between oxcarbazepine and carbamazepine for controlling the crises. CONCLUSIONS:There is moderate evidence indicating that oxcarbazepine is effective as an alternative treatment for partial or generalized epilepsy in children and adults who were refractory to previous treatment. RESUMOCONTEXTO E OBJETIVO: Estima-se que 50 milhões de pessoas no mundo sofrem de epilepsia e cerca de 30% não obterão controle adequado da doença. O objetivo foi de avaliar a efetividade de oxcarbazepina na epilepsia parcial ou generalizada refratária. MÉTODOS:Revisão sistemática. A busca foi nas bases de dados PubMed, Lilacs, EMBASE e CENTRAL. Os estudos foram analisados segundo a metodologia da Cochrane Colaboration. RESULTADOS:Foram incluídos quatro ensaios clínicos aleatórios de média a má qualidade. Entre os pacientes adultos as chances de obterem redução de 50% na frequência de convulsões foram maiores após uso de oxcarbazepina na dose de 600 mg (risco relativo, RR 2.11; intervalo de confiança, IC 95% 1,32 a 3,35; na dose de 1.200 mg (RR 3,24; IC 95% 2,11 a 4,98) e na dose de 2.400 mg (RR 3,83; IC 95% 2,59 a 5,97). Entre as crianças a resposta no grupo usando oxcarbazepina também foi significativamente maior (RR 2,11; IC 95% 1,32 a 3,35). Oxcarbazepina mostrou probabilidade dos pacientes ficarem livre de convulsões, ser eficaz nas doses de 1.200 mg (RR 17,59; IC 95% 2.37 a 130,35) e 2.400 mg (RR 25,41; IC 95% 6,26 a 103,10) não foi eficaz na dose de 600 mg. Não houve diferença estatística significante entre oxcarbazepina e carbamazepina no controle das crises.CONCLUSÕES: Há evidências moderada de que a oxcarbazepina é um tratamento eficaz como alternativa para os casos de epilepsia parcial ou generalizada em crianças e adultos que tenham sido refratários a tratamento prévio.

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“…9,10 The practice of dedicating trials specifically to a given homogeneous population of patients represents a more rational strategy for the development of new antiepileptic drugs in children than testing such drugs on the whole population of refractory epilepsies. Controlled data can be obtained relatively rapidly on limited samples of patients, thus improving ethical acceptability of antiepileptic drug trials in a pediatric population.…”

Section: Efficacymentioning

confidence: 99%

Stiripentol

Chiron

2007

Neurotherapeutics

106

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Summary: Stiripentol (STP) is a new antiepileptic compound made by Biocodex. It recently proved to increase the GABAergic transmission in vitro in an experimental model of immature rat. Clinical studies were based on the fact that STP also acts as an inhibitor of CYP3A4, CYP1A2, and CYP2C19 in vivo in epileptic patients. Whereas the studies in adult patients were disappointing, the trials conducted in pediatric populations demonstrated a specific efficacy of STP in severe myoclonic epilepsy in infancy, Dravet syndrome, when combined with valproate and clobazam. Based on these results, STP was granted orphan drug status in the European Union for the treatment of Dravet syndrome. The French experience in compassionate use suggests that STP might also be of benefit when combined with carbamazepine in pediatric patients with pharmacoresistant partial epilepsy. The interactions of STP with a large number of drugs need to be carefully taken into account, with doses of the combined antiepileptic drugs adjusted to improve the tolerability of the therapeutic association.

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Adjunctive therapy with oxcarbazepine in children with partial seizures

Abstract: OXC adjunctive therapy administered in a dose range of 6 to 51 mg/kg/day (median 31.4 mg/kg/day) is safe, effective, and well tolerated in children with partial seizures.

Cited by 170 publications

References 22 publications

Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [RETIRED]

Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [RETIRED]

Oxcarbazepine for refractory epilepsy: systematic review of the literature

Stiripentol

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