Aggravation of symptomatic occipital epilepsy of childhood by carbamazepine
Abstract
Introduction. Carbamazepine can lead to aggravation of epileptic seizures in generalized epilepsies (primary or secondary) with clinical manifestations of absence (typical or atypical) and/or myoclonic seizures. However, some focal epilepsies can be also aggravated by the introduction of carbamazepine. Case report. We presented a 10-year-old boy born after a complicated and prolonged delivery completed by vacuum extraction, of early psychomotor development within normal limits. At the age of 8 years he had the first epileptic seizure of simple occipital type with generalization and urination. Brain magnetic resonance imaging (MRI) showed focal cortical reductions in the left parietal and occipital regions. Interictal EEG recorded slowed basic activities above the posterior regions of the left hemisphere, with intermittent occurrence of occipital sharp waves and bioccipital sharp and slow-wave complexes. Initially, treatment with valproate was administered; however, the addition of carbamazepine into therapy induced aggravation of seizures and EEG findings, changed behavior and poor performance at school. By withdrawal of carbamazepine the condition improved both clinically and in EEG findings. Conclusion. Childhood occipital epilepsy lesions show deterioration due to carbamazepine, which if administered induces aggravation of seizures, behavior changes, cognition with occurrence of long-term bilateral discharges, and posterior sharp and slow-wave high amplitude complexes recorded by EEG.
References
Shorvon SD. The etiologic classification of epilepsy. Epilepsia 2011; 52(6): 1052−7.
Stephen LJ, Brodie MJ. Pharmacotherapy of epilepsy: newly ap-proved and developmental agents. CNS Drugs 2011; 25(2): 89−107.
Murthy JM. Seizure aggravation with antiepileptic drugs in idiopathic generalized epilepsy. Neurol India 2011; 59(1): 51−2.
Auvin S. Treatment of juvenile myoclonic epilepsy. CNS Neu-rosci Ther 2008; 14(3): 227−33.
Gayatri NA, Livingston JH. Aggravation of epilepsy by anti-epileptic drugs. Dev Med Child Neurol 2006; 48 (5): 394−8.
KikumotoK, Yoshinaga H, Oka M, Ito M, Endoh F, Akiyama T, et al.. EEG and seizure exacerbation induced by carbamazepine in Panayiotopoulos syndrome. Epileptic Disord 2006; 8(1): 53−6.
Caraballo R, Koutroumanidis M, Panayiotopoulos CP, Fejerman N. Idiopathic childhood occipital epilepsy of Gastaut: A review and differentiation from migraine and other Epilepsies. J Child Neurol 2009; 24(12): 1536−42.
Moseley DB, Wirrell EC, Nickels K. Generalized periodic epilep-tiform discharges in child with Dravet syndrome. J Child Neurol 2011; 26(7): 907−10.
Nakken KO, Johannessen SI. Seizure exacerbation caused by an-tiepileptic drugs. Tidsskr Nor Laegeforen 2008; 125(18): 2052−5. (Norwegian)
Camfield P, Camfield C. Monitoring for adverse effects of anti-epileptic drugs. Epilepsia 2006; 47(Suppl 1): 31−4.
Perucca E, Gram L, Avanzini G, Dulac O. Antiepileptic drugs as a cause of worsening seizures. Epilepsia 1998; 39(1): 5−17.
Crespel A, Genton P, Velizarova R, Coubes P, Gelisse P. Wicket spikes misinterpreted as focal abnormalities in idiopathic gene-ralized epilepsy with prescription of carbamazepine leading to paradoxical aggravation. Neurophysiol Clin 2009; 39(3): 139−42.
Panayiotoepoulos CP. A Clinical guide to epileptic syndromes and their treatment. 2nd ed. London: Springler Healthcare Ltd; 2010. p. 135−47.
Kuzniecky R. Symptomatic occipital lobe epilepsy. Epilepsia 1998; 39(Suppl 4): S24−31.
Blume WT, Wiebe S, Tapsell LM. Occipital epilepsy: lateral versus mesial. Brain 2005; 128(5): 1209−25.
Taylor I, Scheffer IE, Berkovic SF. Occipital epilepsies: identifica-tion of specific and newly recognized syndromes. Brain 2003; 126 (4): 753−69.
Jobst BC, Williamson PD, Thadani VM, Gilbert KL, Holmes GL, Morse RP, et al. Intractable occipital lobe epilepsy: Clinical cha-racteristics and surgical treatment. Epilepsia 2010; 51(11): 2334−7.
Andermann F, Zifkin B. The benign occipital epilepsies of childhood: An overview of the idiopathic syndromes and of the relationship to migraine. Epilepsia 1998; 39 (Suppl 4): S9−23.
Terney D, Alving J, Skaarup CN, Wolf P, Beniczky S. The slow-wave component of the interictal epileptiform EEG dis-charges. Epilepsy Res 2010; 90(3): 228−33.
Prasad AN, Stefanelli M, Nagarajan L. Seizure exacerbation and developmental regression with carbamazepin. Can J Neurol Sci 1998; 25(4): 287−94.
Vendrame M, Khurana DS, Cruz M, Melvin J, Valencia I, Legido A, et al. Aggravation of seizure and/or EEG features in children treated with oxcarbazepine monotherapy. Epilepsia 2007; 48(11): 2116−20.
Luciano AL, Shorvon SD. Results of treatment changes in pa-tients with apparently drug-resistant chronic epilepsy. Ann Neurol 2007; 62(4): 375−81.
Bhise VV, Burack GD, Mandelbaum DE. Baseline cognition, be-havior, and motor skills in children with new-onset idiopathic epilepsy. Dev Med Child Neurol 2010; 52(1): 22−6.