Affiliations: Division of Pediatric Neurology, Children's Hospital
and Regional Medical Center and The University of Washington, U.S.A. | Department of Neurology, Sections of Pediatric
Epilepsy, Euclid Avenue, Cleveland, Ohio U.S.A. | Department of Neurology, Sections of Pediatric
Neurology Cleveland Clinic Foundation, Euclid Avenue, Cleveland, Ohio
U.S.A.
Note: [] Correspondence: Prakash Kotagal, M.D., Department of Neurology,
Section of Pediatric Epilepsy, Cleveland Clinic Foundation, 9500 Euclid Avenue,
Cleveland, Ohio 44195 U.S.A. Fax: (216) 445-6617. E-mail: kotagap@ccf.org
Abstract: We retrospectively identified 46 children and adolescents with
partial epilepsy, who failed prior treatment with phenytoin, carbamazepine,
phenobarbital and/or primidone. All patients were subsequently treated with
valproate (VPA). Outcome measurements were stratified into seizure type, simple
partial seizures (SPS), complex partial seizures (CPS) or secondarily
generalized seizures (SGS), or lesions detected by magnetic resonance images
(MRI). The majority of the patients had a ≥ 75% reduction of seizure
frequency. Complete seizure freedom was achieved in 7 (15%) patients.
"Worthwhile" seizure reduction, defined as ≥ 75% decrease (but < 100%) in
seizure activity, was found in 30 (65%) patients. VPA was efficacious in SPS
(2/2), CPS (9/12) and SGS (26/32) patients. Patients with MRI lesions of
vascular insult (6/6), mesial temporal lobe sclerosis (8/10), or malformation
of cortical development (6/7) had a higher response percentage than those
patients with normal MRI findings (11/15) and tumors (5/7). Although the
numbers of patients used in this study were too small for statistical
significance, our results suggest that VPA is a useful medication for previous
medication failures in childhood partial seizures across seizure types as well
as MRI lesions. There is some suggestion that a higher percentage of patients
with MRI lesions may respond favorably to VPA than patients with non-lesional
partial seizures and tumors. (J Pediatr Neurol 2004; 2(4): 199–203).
