Clinical Analysis Of Cutaneous Adverse Drug Reactions Induced By Antiepileptic Drugs In Children

ObjectiveTo retrospectively analysis the clinical data of the children suffered from cutaneous adverse reactions induced by AEDs, and to explore the culprit drugs, clinical characteristics, the therapy and the prognosis, for providing reasonable clinical protocol in treating of cutaneous adverse reactions induced by AEDs in children.MethodsCollected the data of 5218 children who suffered from epilepsy, and charged in department of neurology in children’s hospital of Chongqing medical university. Retrospectively studying the data of 47 cases who were diagnosed cutaneous adverse reactions induced by AEDs. The 47 cases were divided into two groups according to the amount of the culprit AEDs, the single culprit drug group and the multiple culprit drug group. These cases were also divided into two groups according to the severity of clinical manifestation, the mild drug eruption group and AHS group. The data of the age, gender, culprit AEDs, clinical characteristics, the therapy and the outcome of different groups were analyzed and compared. SPSS 21.0 software package were used for data analysis.Results1.There were 27 male and 20 female children, the average ages were (5.32±4.21) years old. There were no significant difference in gender and age between single culprit drug group and multiple culprit drug group, and the same result can be seen between mild drug eruption group and AHS group.2.The incidence of cutaneous adverse reactions induced by different AEDs were:LTG 14.81%, PHT5.00%, CBZ2.84%, OXC1.72%, PB 1.61%, VPA 0.68%, LEV 0.23%. There were no significant difference in the severity of skin eruption between different species of AEDs and between different amounts of AEDs.3.The incubation period of cutaneous adverse reactions induced by different AEDs were 1-90 days. The incubation period between 1-7 days accounted for 38.30%,1-2 weeks accounted for 29.79%,2-3 weeks accounted for 23.40%, and>3weeks accounted for 8.51%.4.All the cases had skin eruption, and the eruptions were be seen on face, body and limbs.39 cases had exanthematous eruptions,1 case had urticaria,3 cases had mild erythema multiforme,4 cases had severe erythema multiforme. The exanthematous eruptions mostly existed in mild drug eruption group, and the severe erythema multiforme only existed in AHS group (P<0.05). The period of skin eruption of AHS group was longer than that of mild drug eruption group (P<0.05).5.Other clinical feature:fever in 32 cases (68.01%), mucosal injury in 8 cases (17.02%), lymphadenopathy in 8cases (17.02%), blood routine abnormalities in 25 cases (53.19%), abnormal liver function in 24 cases (51.06%), abnormal kidney function in 10 cases (21.28%), myocardial injury in 14 cases (29.79%). Fever, lymphadenopathy, blood routine abnormalities, abnormal liver function and myocardial injury mostly were seen in AHS group (P<0.05). There were no significant differences of clinical manifestations between different species AEDs.6.Withdrawing the culprit AEDs in the early stage of therapy could shorten the period of skin eruption (P<0.05). Glucocorticoid therapy were used in 26 cases (55.32%), and IVIG were used in 16 cases (34.04%). In this study, we did not find the role of Glucocorticoid using for shortening the period of skin eruption, for the sample is small. But we found that the skin eruption was more serious, the greater probability of IVIG using.7.In this study, the alternative AEDs were LEV in 9cases, LEV+NZP in 2 cases, LEV+TPM in 1cases, LEV+NZP+TPM in 1cases, NZP in 15 cases, NZP+TPM in 1 cases, TPM in 9cases, VPA in 2cases. No cutaneous adverse reactions happened after using alternative AEDs.Conclusion1. The cutaneous adverse reactions induced by AEDs were idiosyncratic reactions, and were not age-specific and gender-specific reactions. The cutaneous adverse reactions had no relevance with the amount and dosage of AEDs.2. The risk of cutaneous adverse reactions induced by AEDs is much higher in aromatic AEDs, including LTQ PB, CBZ, OXC, PHT. When taking any of these AEDs, we should pay attention to the possibility of the cutaneous adverse reactions, and we should pay attention to VPA and LEV as well.3. If fever, skin eruption, and lymphadenopathy be seen in the early stage of AEDs using, we should do the lab tests, including blood routine examination, liver function test, kidney function test and myocardical enzymes test for early recognize the cutaneous adverse reactions of AEDs, especially for AHS.4. The key point of therapy of the cutaneous adverse reactions induced by AEDs is withdrawing the culprit AEDs as soon as possible, and glucocorticoid and IVIG can be used according to the severity of the cutaneous adverse reactions.5. When there is the cutaneous adverse reactions induced by AEDs, we need to choose other AEDs replacing the culprit AEDs. Benzodiazepines may be more safe than other AEDs, and we should avoid choosing the AEDs which may have cross-reactivity with the culprit AEDs.