OLD DRUGS VERSUS NEW IN THE TREATMENT OF CHILDHOOD EPILEPSY
In the last twenty years a dozen new anti-epileptic drugs (AEDs) have been licensed for clinical use. Studies in adults show that these newer AEDs aren’t necessarily better at controlling seizures than the older ones, but they have been linked to fewer unwanted side effects (i.e. better tolerability). In children, however, there are very limited data available to neurologists comparing the effectiveness of old versus new AEDs, and so it is difficult for them to know which drug is best to prescribe first. Researchers at the Dr. Behçet Uz Children’s Hospital, the Dokuz Eylul University Hospital and the Ege University Hospital, all in Turkey, have tried to address this.
In a recent study the team recruited 289 children (141 girls and 148 boys) with new-onset epilepsy. Thirty-three children received phenobarbital as their first treatment, 142 received sodium valproate, 42 received carbamazepine, 38 received oxcarbazepine and 34 received levetiracetam. All the groups were similar in terms of proportion of girls and boys, age, and type and severity of epilepsy. The groups were monitored for 12 months, and the researchers assessed the efficacy and tolerability of the different drugs. A comparison was made between the old AEDs (sodium valproate, carbamazepine and phenobarbital) and the new ones (oxcarbazepine and levetiracetam).
During the study, 245 children (84.8%) remained seizure free. When the researchers compared the different treatment groups, they found that the rate of seizure control did not differ statistically between them. When they compared these children with the 44 for whom treatment had failed (either due to a lack of seizure control (29 children) or intolerable side effects (15 children)), there were no obvious patterns – i.e. treatment failure wasn’t linked to gender, age or seizure type.
Looking at tolerability, a total of 80 children (27.7%) reported unpleasant side effects, and the most common were behavioral problems, nausea and/or vomiting, weight gain and learning difficulties. Again there was no statistical difference between the groups in terms of the side effects experienced.
These findings suggest that there is no difference in the efficacy and tolerability of old and new AEDs when given as first treatments for children. This is reassuring for those who have already been prescribed AEDs, but it is also disappointing because it implies that new AEDs have made little difference to seizure control in newly-diagnosed children. This study highlights the importance of identifying novel mechanisms to target with new drugs.