Factors Predicting Poor Response to First Antiepileptic Drug in Pediatric Epilepsy
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Abstract
Background: Epilepsy in children is a common neurological disease as well as pharmacotherapy remains a treatment of choice. However, first line antiepileptic drug can effectively control seizure in approximately 60 to 70 percent although 30 to 40 percent required second medication. This study aimed to acknowledge factors affecting the use of antiepileptic drug more than one, to consider the second antiepileptic drug for improving seizures control.
Objective: To identify the factor affecting the use of more than one antiepileptic drug in the control of seizures
Methods: A retrospective study was conducted with patient, in the department of pediatric in Surin hospital. Who had been diagnosed epilepsy and on antiepileptic drug more than 6 months, from January 2016 to December 2018. The Fisher’s exact test, Univariable logistic regression and multiple logistic regression was used in the analysis.
Results: The results showed that 48 patients (30.6%) out of the total 157 epilepsy used more than one antiepileptic drug. The mean age is 58.42 ± 4.5 months, females are found more than males. In the univariable analysis found that factors affecting the use of more than 1 antiepileptic drug were female (OR 2.04, 95% CI 1.02 - 4.06, p-value = 0.043), history of neonatal seizures (OR 15.43, 95% CI 1.80 - 132.03, p-value = 0.012), multiple seizure type (OR 5.25, 95% CI 1.50-18.40, p-value = 0.010), symptomatic epilepsy (OR 0.31, 95% CI 0.15-0.67, p-value = 0.003), history of delay development (OR 4.06, 95% CI 1.96 - 8.43, p-value=< 0.001), neurological deficit (OR 2.91, 95% CI 1.30 - 6.47, p-value = 0.009). abnormal imaging (OR 2.77, 95% CI 1.31 – 5.85, p-value = 0.007) abnormal EEG (OR 6.31, 95% CI 2.61 - 15.27, p-value =< 0.001). In the multivariable logistic analysis, it was found that history of delay development (OR 4.30 , 95% CI 1.04 – 17.72, p-value = 0.043) abnormal imaging (OR 4.15 , 95% CI 1.14 – 15.13, p-value =0.031) abnormal EEG (OR 5.21 ,95% CI 1.73 –15.70, p-value = 0.003) are main factor that has a statistically significant effect on the use of more than one antiepileptic drug
Conclusion: Considering history of delay development, abnormal imaging and abnormal EEG in children with epilepsy along with rapidly establish second antiepileptic drug would be beneficial for them to control seizure.
Keywords: Pediatric epilepsy, first antiepileptic drug
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References
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