Abstracts

Rationale: Over the last few years oxcarbazepine has emerged as a frequently used first line medication for children with partial onset seizures.Carbamazepine is well known to aggravate seizures and bring out EEG changes. Oxcarbazepine a keto analog of carbamazepine is also reported to aggravate seizures. Here we report 3 children with 2 different seizure syndromes who had seizure exacerbation or appearence of new seizure type on oxcarbazepine. Methods: Three children (all girls, age 2years - 8 years) were identified based on seizure semiology and interictal EEG as having partial onset epilepsy and started on oxcarbazepine. In patient # 1 semiology consisted of premonitory nausea, followed by limpness, eye deviation to the left and tremoring with altered consciousness. The interictal EEG showed right central and temporal epileptiform discharges. Seizures in patient # 2 were characterized by left facial parasthesia and twitching, sometimes associated with left arm stiffening. Occasionally she had generalized seizures in sleep. Patient # 3 had bilateral clonic seizures involving upper extremities with loss of consciousness. Two interictal EEGs were normal. All three had normal /non- specific MRI abnormalities. Patients one and three had a family history of febrile seizures, while patient two had a family history of epilepsy. Results: While on oxcarbazepine, patient # 1 developed staring spells with uprolling of eyes, fluttering of eyelids and unresponsiveness. Some episodes were also associated with loss of tone resulting in a fall. The ictal EEG showed generalized spike-and-wave. Oxcarbazepine was withdrawn. She responded well to ethosuximide. Patient # 2 showed an increase in seizure frequency and significant behavioral problems on Oxcarbazepine. The interictal EEG showed frequent independent and bilateral, right more than left centro-temporal spike-wave activated in sleep. Oxcarbazepine was stopped. She became seizure free on levatiracetam. Patient number three showed a dramatic increase in seizure frequency (several a day) on oxcarbazepine. The ictal EEG showed generalized spike-wave. Upon withdrawing oxcarbazepine and starting valproic acid, she became seizure free. Patient # 3 developed a dramatic increase in seizure frequency (several a day) on oxcarbazepine. The ictal EEG showed generalized spike-waves. Upon withdrawing oxcarbazepine and starting valproic acid she became seizure free. Conclusions: We present three children with two different epilepsy syndromes who showed seizure aggravation with oxcarbazepine, a drug widely used for partial seizures. In retrospect, patients one and three probably had the syndrome of GEFS plus, while patient two had a benign focal epilepsy of childhood. As the seizure syndrome may be unclear at onset , the treating physician faces a therapeutic challenge. While it is not unreasonable to use oxcarbazepine even when the seizure syndrome is uncertain, close clinical follow-up with an awareness of this uncommon side effect of seizure exacerbation by oxcarbazepine is warranted.