An. Prasad et al., SEIZURE EXACERBATION AND DEVELOPMENTAL REGRESSION WITH CARBAMAZEPINE, Canadian journal of neurological sciences, 25(4), 1998, pp. 287-294
Background: Unexpected exacerbation of seizures may occur following in
itiation of treatment with carbamazepine (CBZ). We reviewed the occurr
ence of such reactions in our patient population at a tertiary care ch
ildren's hospital. Methods: A retrospective analysis of our clinic dat
abase identified 129/691 (18.6%) patients with epilepsy treated with C
BZ, as monotherapy. 38/129 children were later switched to another dru
g. In 11/38 (28.5%) clinical and/or EEG deterioration was observed. Tw
o patients identified at another institution with similar exacerbation
were also included in our analysis. We report on the findings in thes
e 13 cases. Results: Two groups were identified: Group I - 6 patients
with normal neurological exam, normal EEG background, and a diagnosis
of idiopathic generalized epilepsy. Group II - 7 patients with an abno
rmal neurological exam and/or abnormal EEG background. Following intro
duction of CBZ therapy, worsening of preexisting seizures, appearance
of new seizure types, behavioral regression, and accompanying EEG dete
rioration were reported in both groups. Dramatic improvement in seizur
e control occurred, following withdrawal of CBZ and substitution of an
other anticonvulsant. Conclusion: Physicians treating epilepsy must be
aware that CBZ can exacerbate seizures, and cause developmental regre
ssion in children. Careful patient selection, when choosing CBZ as tre
atment, and prompt recognition of clinical deterioration and intervent
ion, may help avoid or reverse these paradoxical reactions.