Treatment of Epilepsy

Date: 05 Jul 2007
Author: Nick Henwood

Cheap and effective drugs exist but are not accessible to most patients. In many settings epilepsy is a low priority health issue. Do CHGN members have experience of good practice in the care of epilepsy? We'd be glad to hear from you.

Of the 35 million people with epilepsy who live in developing countries, around 85% receive no treatment at all. As a consequence, they experience morbidity related to seizures and the psychosocial consequences of stigma and discrimination. Regrettably, most of these people—many of whom are children—could have their seizures completely controlled and they could return to a normal life by taking a single daily dose of a drug that costs less than (US$3 £1.50) each year. In this week's BMJ, a randomised controlled trial in Bangladesh by Banu and colleagues compares the effects of carbamazepine and phenobarbital on seizure control and behavioural side effects in 108 children with epilepsy.

Side effects of phenobarbital and carbamazepine in childhood epilepsy: a randomised controlled trial. (Child Development and Neurology Unit, Dhaka Shishu (Children's) Hospital, Bangladesh Institute of Child Health, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh, Neurosciences Unit, UCL, Institute of Child Health, Wolfson Centre, London WC1N 2AP)

Results: 91 children were followed up for 12 months. Six required a change of antiepilepsy drug. Side effects were compared in 85 children. In the last quarter of the 12 month follow-up, 71 children were seizure free after one year's treatment. Thirty two in the phenobarbital group and 39 in the carbamazepine group had no seizures in 74 and 102 days after randomisation, respectively. Ten children had increased behavioural problems, which were unacceptable in four (one in the phenobarbital group and three in the carbamazepine group). Independent t tests, however, showed no difference between the two trial drugs.

Conclusion: There was no excess in behavioural side effects with phenobarbital in children with epilepsy in a country with limited resources.

Phenobarbital is the reasonable first choice for childhood epilepsy in resource-poor settings.

Reference

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