Efficacy of carbamazepine, valproate and topiramate in the treatment of medial temporal epilepsy in children

For a retrospective observational investigation based on real clinical practice of relative efficacy of valpoic acid (VPA), carbamazepine (CBZ) and topiramate (TPM) we have selected 205 patient with age of seizure onset before 16 years with a undoubted diagnosis of medial temporal lobe epilepsy, who had received treatment according to ILAE recommendations, and observation time since the last treatment change was from 2 to 5 years. The groups of patient receiving CBZ, VPA H TPM did not differ significantly in presenting unfavorable prognostic factors and dose regimes that allowed to conduct direct comparison of efficacy of the investigated drugs. Efficacy of VPA in children with medial temporal lobe epilepsy was higher compared with CBZ (79% vs 61%; p<0,05) and TPM (79% vs 53%; p<0.001). CBZ caused seizure aggravation more frequently than VPA (10% vs 1%; p<0,001). In case of presence of clinico-electroencephalografic signs of significant organic brain damage and in patient with seizure onset before age of 1 year CBZ was not effective while TPM showed efficacy of 20%, (p<0,05) and VPA was the most effective drug in this case (50%; p<0,001). In case of focal cortical dysphasia or the states after periventricular leucomalacia the efficacy of CBZ was lower than VPA (0% for CBZ vs 89% for VPA p<0,01 and 40% for CBZ vs 77% for VPA p<0,05, respectively) and TPM (0% for CBZ vs 100% for TPM p<0,01 and 40% for CBZ vs 100% for TPM p<0,01, respectively). In MRI-negative cases VPA was most effective (90% vs 53% for CBZ; p<0,001 and 67% for TPM; p<0,05). Efficacy CBZ reduces proportionally the number of previously used antiepileptic drugs (AEDs) (52% as a first AED vs 17% as a second AED; p<0,01), this tendency is noted also for TPM but in less extend (80% vs 46%, respectively p<0,05), but not for VPA (77% vs 75%; p>0,05, respectively). Adverse effects were more frequent during treatment with CBZ, than VPA (19% vs 5%; p<0,001) and TPM (19% vs 9%; p<0,05).