Benign childhood epilepsy with centrotemporal spikes: to treat or not to treat

Soonhak Kwon, Tae Gyu Hwang, Junhwa Lee, Doo-Kwun Kim, Hye-Eun Seo, Soonhak Kwon, Tae Gyu Hwang, Junhwa Lee, Doo-Kwun Kim, Hye-Eun Seo

Abstract

Background and purpose: The aim of this study was to evaluate the benefits and risks of oxcarbazepine (OXC) monotherapy in children with newly diagnosed, benign partial epilepsy based on clinico-electrical and neuropsychological evaluation over time.

Methods: The study was open label, prospective, multicenter based. A total of 39 children with BRE were involved in the study. They were randomized into two groups (T; treatment with OXC, NT; No treatment) to compare the effectiveness of OXC treatment. All children underwent EEGs with quantification and a comprehensive battery of neuropsychological tests at the first visit and follow up visit at 6 months.

Results: The subjects made a slight progress in general intelligence measures over time in both groups (95.4±10.5 to 97.6±7.5 for T, 107.6±17.3 to 111.4±18.6 for NT). Memory and frontal executive functions did not change over time in both groups in terms of the memory quotient (MQ) (106.7±27.5 to 103.4± 19.3 for T, 105.8±13.2 to 104.9±17.2 for NT) and executive intelligence quotient (EIQ) (114.7±18.3 to 108.9±12.5 for T, 100.6±25.1 to 101.2±13.9 for NT). However, when sub-domain scores were compared between the two groups, the treatment group got significantly worse over time in the verbal fluency test (11.5±3.8 to 8.0±1.4 for T, 10.3±3.9 to 11.5±2.1 for NT; p<0.05) and level 1 of Stroop test (9.3±3.0 to 7.5±1.3 for T, 11.0±3.7 to 11.2±2.6 for NT; p<0.05). The subjects might have cognitive and behavioral difficulties in association with frontal lobe dysfunctions, but these difficulties did not seem to be dependent on the number of seizures, the abundance of subclinical epileptiform discharges, or the anti-epileptic treatment.

Conclusions: We think that OXC monotherapy is effective for children with BRE, but is to be given to the selected patients such as patients with prolonged or frequent seizures. However, further studies are needed to have a better understanding in this matter.

Keywords: Behavior; Child; Cognition Disorders; Epilepsies; Neuropsychological tests; Partial.

Figures

Figure 1
Figure 1
Study design. The subjects were randomized into two groups (treatment with OXC, No treatment) to compare the effectiveness of OXC treatment. In the treatment group, OXC was given once a day or twice a day at the same dose. All children underwent sleep EEGs and comprehensive neuropsychological tests at the first and 6 month follow up visits.
Figure 2
Figure 2
Verbal fluency and Stroop tests between treatment and non-treatment groups. The scores for the word and verbal fluency and level 1 Stroop tests for the treatment group got significantly got worse over time when compared with the non-treatment group.

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