1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-12-76-a 10.15844/pedneurbriefs-12-10-5 Antiepileptic Drugs Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Carbamazepine Exacerbation of Absence Epilepsy http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 10 1998 01 05 2016 12 10 76 76 Copyright: © 1998 The Author(s) 1998 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Inappropriate use of carbamazepine and vigabatrin in typical absence seizures

The inappropriate use of carbamazepine (CBZ) in 8 children, and vigabatrin (VGB) in 2, among 18 consecutive referrals of children with resistant typical absence seizures, is reported from St Thomas’ and Guy’s Hospitals, London, UK.

 Carbamazepine Exacerbation of Absence Seizures Myoclonic Epilepsies Sodium Valproate

The inappropriate use of carbamazepine (CBZ) in 8 children, and vigabatrin (VGB) in 2, among 18 consecutive referrals of children with resistant typical absence seizures, is reported from St Thomas’ and Guy’s Hospitals, London, UK. Frequency of absences had increased in 4 of the children who received CBZ and 2 of these developed myoclonic jerks in addition, which resolved after CBZ withdrawal. Typical absence epilepsy was confirmed by EEG, video-EEG, or both. Subsequent control of seizures was obtained with valproate, lamotrigine, or ethosuximide. [1]

COMMENT. Carbamazepine and vigabatrin may exacerbate or induce typical absence seizures. These AEDs are also contraindicated in myoclonic epilepsies. Patients with absence seizures who fail to respond to sodium valproate or ethosuximide should be treated with either lamotrigine, acetazolamide, or clonazepam. The inappropriate second choice of CBZ or VGB after VPA failure in the patients referred above was unexplained, but misdiagnosis as partial seizures was a possible reason. EEG correlation or video-EEG is essential in arriving at a correct diagnosis. Although the carbamazepine exacerbation of absence seizures has been known since 1974 (Cereghino et al), this report from London and that from Switzerland suggest that clinicians are not sufficiently aware of the hazards of inappropriate use of AEDs.

Parker AP Agathonikou A Robinson RO Panayiotopoulos CP Inappropriate use of carbamazepine and vigabatrin in typical absence seizures Dev Med Child Neurol 1998 Aug 40 8 517 519 10.1111/j.1469-8749.1998.tb15409.x 9746003