RELATIONSHIP OF CARBAMAZEPINE REDUCTION RATE TO SEIZURE FREQUENCY DURING INPATIENT TELEMETRY

To establish guidelines for medication reduction during inpatient tele metry, the records of 18 children and young adults with refractory par tial seizures undergoing carbamazepine (CBZ) reductions during continu ous video/EEG telemetry were reviewed. Six patients were receiving CBZ monotherapy, and 12 patients were treated with an additional antiepil eptic drug (AED) maintained at baseline dosage during CBZ taper. Despi te relatively rapid mean reductions in dosage of 44% by day 2 of taper , no patients experienced frequent repetitive seizures or status epile pticus (SE). Seizure rate during the entire CBZ reduction period corre lated significantly with rate of drug reduction. Linear regression ana lysis showed drug reduction rate to be a good predictor of seizure rat e. Fourteen patients experienced at least three seizures during CBZ ta per. On the average, the third seizure occurred on day 5 of taper at a percentage of dose reduction of 79%. In 8 patients, CBZ concentration s were measured both before taper and less than or equal to 24 h after the third seizure. For these patients, seizure rate also correlated s ignificantly with reduction in CBZ level. We conclude that manipulatio n of CBZ dose reduction rate is important in maximizing seizure freque ncy during telemetry and, in our patients, a relatively rapid rate of dose reduction was safe and effective in promoting seizure recordings.