First, Do No Harm: The Risks Of Overtreating Children With Epilepsy

Background: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. Objective: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. Method: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. Results: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). Conclusion: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.65114Camfield, C.S., Camfield, P., Gordon, K., Smith, B., Dooley, J., Outcome of childhood epilepsy: A population-based study with a simple scoring system for those treated with medication (1993) J Pediatr, 122, pp. 861-868Silva, M., MacArdle, B., MaGowan, M., Randomised comparative monotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed childhood epilepsy (1996) Lancet, 347, pp. 709-713Baulac, M., Rational conversion from antiepileptic polytherapy to monotherapy (2003) Epileptic Disord, 5, pp. 125-132Holmes, G.L., Overtreatment in children with epilepsy (2002) Epilepsy Res, 52, pp. 35-42Fischbacher, E., Effect of reduction of anticonvulsants on wellbeing (1982) Br Med J (Clin Res Ed), 285, pp. 423-424Schmidt, D., Reduction of two-drug therapy in intractable epilepsy (1983) Epilepsia, 24, pp. 368-376Alvarez, N., Discontinuance of antiepileptic medications in patients with developmental disability and diagnosis of epilepsy (1989) Am J Ment Retard, 93, pp. 593-595Guerrini, R., Belmonte, A., Genton, P., Antiepileptic drug-induced worsening of seizures in children (1998) Epilepsia, 39 (SUPPL. 3), pp. S2-S10TS, K., Holmes, G.L., EEG and clinical predictors of medically intractable childhood epilepsy (1999) Clin Neurophysiol, 110, pp. 1245-1251Huttenlocker, P.R., Hapke, R.J., A follow-up study of intractable seizures in childhood (1990) Ann Neurol, 28, pp. 699-705Ferngren, H., Akerstrom, I., Rane, A., Mono or polypharmacotherapy in institutionalized epileptic children with severe mental retardation? A team approach for optimizing antiepileptic therapy (1991) Acta Paediatr Scand, 80, pp. 458-465Dooley, J., Gordon, K., Camfield, C., Smith, E., Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: A prospective study (1996) Neurology, 46, pp. 969-974Shinnar, S., Berg, A.T., Moshé, S.L., Discontinuing antiepileptic drugs in children with epilepsy:a prospective study (1994) Ann Neurol, 35, pp. 534-545Shorvon, S.D., Reynolds, E.H., Unnecessary polypharmacy for epilepsy (1977) Br Med J, 1, pp. 1635-1637Vickery, B.G., Hay, R., Engel, J., Outcome assessment for epilepsy surgery: The impact of measuring health-related quality of life (1995) Ann Neurol, 37, pp. 158-16

What About Us?. Siblings Of Children With Epilepsy

Rationale: It is known that epilepsy has a severe impact in the quality of life of the patients; however, it affects the lives of all family members. The psychosocial repercussions of epilepsy are often of greater significance than the seizures themselves. Methods: This was a prospective study, conducted from January 2005 to December 2005 at the pediatric epilepsy clinic of our University Hospital. Parents were interviewed by one of the authors according to a structured questionnaire about the impact of epilepsy in the life of the siblings of children with epilepsy. Results: One hundred and twenty-seven children, siblings of 78 patients with epilepsy were evaluated. From the 127 siblings of children with epilepsy, 60 were girls and 67 were boys. Ages ranged from 5 to 18 years old (mean = 11.7 years). After the diagnosis of epilepsy, the siblings had only negative feelings toward the disease, mostly sadness and fear. Conclusion: Our data showed that the impact of epilepsy in the lives of siblings of children with epilepsy is much more severe than previously suspected. © 2006 British Epilepsy Association.158610614Wong, J., Wirrel, E., Physical activity in children/teens with epilepsy compared with that in theirs siblings without epilepsy (2006) Epilepsia, 47, pp. 631-639Wirrel, E., Blackman, M., Barlow, K., Mah, J., Hamiwka, L., Sleep disturbances in children with epilepsy compared with their nearest-aged siblings (2005) Dev Med Child Neurol, 47, pp. 754-759Baker, G.A., Jacoby, A., Buck, D., Stalgis, C., Monnet, D., Quality of life of people with epilepsy: an European study (1997) Epilepsia, 38, pp. 353-362Baker, G.A., Brooks, J., Buck, D., Jacoby, A., The stigma of epilepsy: an European perspective (1999) Epilepsia, 41, pp. 98-104Suurmeijer, T.P.B.M., Reuvekamp, M.F., Aldenkamp, B.P., Social functioning, psychological functioning, and quality of life in epilepsy (2001) Epilepsia, 42, pp. 1160-1168WirrelI, E.C., Camfield, C.S., Camfield, P.R., Dooley, J.M., Gordon, K.E., Smith, B., Long term psychosocial outcome in typical absence epilepsy (1997) Arch Pediatr Adolesc Med, 151, pp. 152-158Pal, D.K., Epilepsy control in the twenty-first century: hidden impact on children and families (2003) Child Care Health Dev, 29, pp. 233-236Camfield, C., Breau, L., Camfield, P., Impact of pediatric epilepsy on the family: a new scale for clinical and research use (2001) Epilepsia, 42, pp. 104-112Souza, E.A.P., Nista, C.R., Scotoni, A.E., Guerreiro, M.M., Sentimentos e reações de pais de crianças epilépticas (1998) Arquivos de Neuropsiquiatria, 56, pp. 39-44Fernandes, P.T., Souza, E.A.P., Identification of family variables in parents' groups of children with epilepsy (2001) Arquivos de Neuropsiquiatria, 59, pp. 854-858Hoare, P., Russell, M., The quality of life of children with chronic epilepsy and their families: preliminary findings with a new assessment measure (1995) Dev Med Child Neurol, 37, pp. 689-696Pal, D.K., Epilepsy control in the twenty-first century: hidden impact on children and families (2003) Child Health Care Dev, 29, pp. 233-236Lähteenmäki, P.M., Sjöblom, J., Korhonen, T., Salmi, T.T., The siblings of childhood cancer patients need early support: a follow up study over the first year (2004) Arch Dis Child, 89, pp. 1008-1013Houtzager, B.A., Grootenhuis, M.A., Hoekstra-Weebers, J.E., Last, B.F., One month after diagnosis: quality of life, coping and previous functioning in siblings of children with cancer (2005) Child Care Health Dev, 31 (1), pp. 75-87Cairns, N.U., Clark, G.M., Smith, S.D., Lansky, S.B., Adaptation of siblings to childhood malignancy (1979) J Pediatr, 95, pp. 484-487Mancuso, M.G., Bishop, S., Blakeney, P., Robert, R., Gaa, J., Impact on the family: psychosocial adjustment of siblings of children who survive serious burns (2003) J Burn Care Rehabil, 24, pp. 110-118Fernandes, P.T., Cabral, P., Araujo, U., Noronha, A.L., Li, L.M., Kids' perception about epilepsy (2005) Epilepsy Behav, 6, pp. 601-603Hoare, P., Kerley, S., Psychosocial adjustment of children with chronic epilepsy and their families (1991) Dev Med Child Neurol, 33, pp. 201-215Cheung, C., Wirrel, E., Adolescents' perception of epilepsy compared with other chronic diseases: "through a teenager's eyes" (2006) J Child Neurol, 21, pp. 214-222Houtzager, B.A., Grootenhuis, M.A., Caron, H.N., Last, B.F., Sibling self-report, parental proxies, and quality of life: the importance of multiple informants for siblings of a critically ill child (2005) Pediatr Hematol Oncol, 22, pp. 25-40Houtzager, B.A., Oort, F.J., Hoekstra-Weebers, J.E.H.M., Caron, H.N., Grootenhuis, M.A., Last, B.F., Coping and family functioning predict longitudinal psychological adaptation of siblings of childhood cancer patients (2004) J Pediatr Psychol, 29, pp. 591-605Hoare, P., Kerley, S., Helping parents and children with epilepsy cope successfully: the outcome of a group programme for parents (1992) J Psychosom Res, 36, pp. 759-76