Do antiepileptic drugs differ in suppressing interictal epileptiform activity in children?

Antiepileptic drugs may suppress interictal epileptiform activity in additi on to suppressing seizures, although the comparative rates of suppression o f interictal epileptiform activity for phenobarbital (PHB), carbamazepine ( CBZ), and valproate (VPA) in children are unknown. Electroencephalogram (EE G) pairs were identified in which the first tracing illustrated interictal epileptiform activity before antiepileptic drug treatment; the rate of clea rance of such activity in the subsequent tracing was assessed according to the drug introduced. EEG pairs (n = 213) were identified for CBZ, PHB, and VPA. Overall suppression rates of epileptiform activity in the second EEG w ere 12/55 (22%) for PHB, 27/81 (33%) for CBZ, and 35/77 (46%) for VPA (P = 0.005 for VPA vs PHB). When suppression rates were assessed comparing sleep -state pairs, suppression rates were 24/80 (30%) for PHB, 51/129 (40%) for CBZ, and 60/120 (50%) for VPA (P = 0.005 for PHB vs VPA). A subanalysis for focal discharges yielded suppression rates of 10/43 (23%) for PHB, 19/60 ( 32%) for CBZ, and 8/19 (42%) for VPA; for generalized discharges, 2/12 (17% ) for PHB, 8/21 (38%) for CBZ, and 27/58 (47%) for VPA. VPA, and to a lesse r extent CBZ, appeared superior to PHB in suppressing interictal epileptifo rm activity, including both focal and generalized epileptiform activity. (C ) 2001 by Elsevier Science Inc. All rights reserved.