Distúrbios cerebrais e terapia

Abstrato

The Contrast of Efficacy and Safety between Carbamazepine and Other Antiepileptic Drugs in Patients with Postencephalitic Epilepsy: Experience from a Developing Country

Ying-Ying Li, Zhi-Hui Zhou, Nong Xiao, Yang-Mei Chen and Wen Feng Song

Background: Viral encephalitis may cause potentially devastating sequelae, including post-encephalitic epilepsy (PEE) and refractory epilepsy. The purpose of this study was to analyze the efficacy and safety of several antiepileptic drugs (AEDs) in PEE.

Methods: A cohort of patients diagnosed with PEE related to presumed encephalitis was retrospectively studied. Patients were divided into different antiepileptic drug groups. Retention rates, 50% responder rates, remission rates and adverse events were evaluated. Several risk factors for adverse events were assessed, including gender, age and drug choice.

Results: Two hundred and ninety-two patients were enrolled in this study. PEE manifestations occurred mainly in children. Secondary generalized tonic-clonic seizure (SGTCS) was the frequent type in PEE patients. In the first year, in descending order, the retention rates: Carbamazepine (CBZ) > Topiramate(TPM) Phenobarbital(PB) > Sodium Valproate (VPA-Na) Combined > Magnesium Valproate (VPA-Mg) (P < 0.05, CBZ’s was higher than VPAMg’s and Combined therapy’s), the 50% responder rates were: PB > VPA-Mg > VPANa > TPM > CBZ > Combined (P < 0.05, PB’s and VPA-Mg’s are higher than Combined therapy), the remission rates: VPA-Mg > TPM > CBZ > PB > VPA-Na > Phenytoin Sodium (PHT) > Combined (P < 0.05, TPM’s and VPA-Mg’s are higher than combined therapy’s). In decreasing order, the rates for serious adverse effects were: PHT > TPM > CBZ > PB > VPA-Na > Combined > VPA-Mg.

Conclusions: Considering the retention rates, remission rates, 50% responder rates and adverse effects together, we suggest that, compared to CBZ, TPM and VPA-Na should be the good alternatives for PEE patients. When considering the cost together, PB should be another choice in PEE. It is worthy to enlarge the sample size of VPA-Mg to further confirm its good efficacy and safety. And PHT was not recommended for PEE patients.