EEG CHANGES AND SEIZURE EXACERBATION IN YOUNG-CHILDREN TREATED WITH CARBAMAZEPINE

Carbamazepine (CBZ) has been reported to exacerbate some seizure types in children. We studied the correlation between CBZ-associated EEG ch anges and seizure exacerbation in 59 children aged <6 years treated wi th 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 impro ved 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 pre dominantly by new appearance of generalized spike/polyspike-and-wave d ischarges (group II). The majority of these patients (65%) experienced seizure exacerbation (p < 0.001). For group I, symptomatic partial ep ilepsy, idiopathic focal epilepsy, and complex febrile seizures were s ignificantly more common; in group II, cryptogenic seizure disorders w ere more common (p < 0.005). Children in group I were more likely to r emain on CBZ or to be weaned from medication after successful treatmen t, whereas children in group II required additional medication(s) or c omplete discontinuation of CBZ. Our results suggest that new appearanc e of generalized paroxysmal discharges after treatment is highly corre lated 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.