Retention Rates Of Five Types Of Antiepileptic Drug Monotherapy On Children With Epileptic Patients, A Comparative Study

BackgroundIn our country, the incidence of epilepsy in children was 151/10 million, the prevalence rate was 3.45‰.While the foreign reports the prevalence rate of 0.5%-0.8%.With the deepening of people understanding of epilepsy and epileptic syndromes and extensive clinical application of antiepileptic drugs(AEDs),at present 75%～75% of children with epilepsy seizures can get ideal control.But the 20% to 25% of patients still can’t get effective control after treatment with AEDs.The main purpose of AEDs treatment is to control the seizures or minimize episodes, long-term treatment has no obvious adverse reactions.Therefore, choosing the appropriate AEDs is the key to the treatment.Drug retention rate which comprehensive reflects the patients for long-term treatment effectiveness of certain drugs, safety, economy and the degree of recognition, is a new standard evaluation of antiepileptic drugs. And retention rate can better show efficacy and tolerability of AEDs.What our medical workers need to do is how to choose the high levels of scientific, standardized, low-cost treatment method for children.ObjectiveComparing retention rates of five types of antiepileptic drugs (AEDs) in children patients with newly diagnosed epilepsy in order to provide the basis for drug choice of the maintence therapy in children patients with epilepsy.MethodsCollected the database between January 2002 and January 2012 in our department of neurology clinic data of newly diagnosed children with epilepsy, which respectively accepted carbamazepine (CBZ),valproic acid (VPA), topiramate (TPM), oxcarbazepine (OXC) and lamotrigine (LTG) monotherapy. Through the outpatient follow-up and telephone follow-up, follow-up of patients with onset, adverse reactions and drug withdrawal. Comparison of the 6 month,12 months and 24 months of single drug retention rate. The drug retention rate and survival assessment were made with parametric assessment by Kaplan-Meier method through application of SPSS 19.0 software. Retention rates among the groups were made by Log-rank test. Finally, analyzed and summarized.ResultsA total of 492 AED exposures were obtained (CBZ=110, VPA=206, OXC=44, LTG=60, TPM=72) from patients with child epilepsy.There are 288 male patients and 204 female patients, aged 1.1～14 years old. The follow-up time were 2～5 years. There are 293 partial seizures (PS) and 199 generalized seizures (GS) which does not include spastic generalized seizures and myoclonic seizures. At 2 years, monotherapy retention rate was highest with LTG (68.3%),followed by OXC (65.9%), TPM (59.7%), VPA (55.3%) and CBZ (45.5%). This study showed highest retention rate with LTG,which was significantly different from CBZ and VPA, P<0.05.There are no significant difference among OXC and TPM. When these AEDs were discontinued, it was mainly due to poor compliance.Poor efficacy in children and other factors are also important reasons for discontinuation.The LTG group because of poor compliance withdrawal rate is the lowest(0%),which CBZ group is the highest.ConclutionAs the drug of choice for the treatment of epilepsy in children LTG, OXC and TPM are more suitable.The main reasons leading to the withdrawal of children were high incidence of adverse effects and poor compliance.