A CROSS-SECTIONAL STUDY ON SODIUM VALPROATE, CARBAMAZEPINE, AND LEVETIRACETAM INDUCING ENURESIS IN EPILEPTIC CHILDREN

Objectives: Enuresis or bedwetting is considered to be an underreported ADR of antiepileptic drugs (AEDs). This study assesses the incidence and comparative rate of occurrence of enuresis in children with epilepsy who are on AEDs treatment such as sodium valproate (SV); carbamazepine and levetiracetam (LEV). Methods: The study was conducted with a sample size of 32 patients. Both inpatients and outpatients between the age group >5–18 years of age previously diagnosed with epilepsy that is on monotherapy and polytherapy with SV or carbamazepine or LEV were included in the study. Patients with urinary complications or urogenital abnormalities past 3 months before admission were excluded from the study. Assessment of enuresis was done based on a questionnaire prepared from NICE guidelines and analyzed using SPSS software version 20. Results: Of 44 patients who were included in the study, only 34 came for review. Analysis of the questionnaire showed the occurrence of enuresis in 12 patients. Drugs prescribed versus assessment questions showed potent significance with eight questions; hence the hypothesis that the prescribed drugs can cause enuresis can be taken into consideration. The rate of occurrence of enuresis was analyzed in all the drugs with their respective doses, but the significant values were found only for SV 200 mg. Conclusion: This study shows the possibility of enuresis in LEV and SV treatment with a significant difference in SV. Furthermore, it showed a relation between the duration of treatment and the occurrence of enuresis.

Association of Psychiatric Disorders in Children and Adolescents with Epilepsy in a Tertiary Care Hospital in Bangladesh

Background Psychiatric disorders are important aspects of epilepsy and have received increasing attention in the last several years. Although a significant number of children are afflicted with epilepsy with psychiatric comorbidities, the actual burden was not evaluated sufficiently. Objective To determine the types and frequency of psychiatric disorders in children with epilepsy. Materials and Methods This hospital-based case-control study was conducted at the outpatient department of a tertiary care center in Dhaka, Bangladesh, from September 2018 to August 2019. In total, 68 epileptic children, ranging from 5 to 17 years of age, were enrolled as cases. A similar number of nonepileptic children of age, sex, and sociodemographic status matched were enrolled as control. Parent, teacher, and self-version of Bengali Development and Well-Being Assessment (DAWBA) were used to assess the psychiatric disorders, and the diagnosis was assigned as Diagnostic and Statistical Manual (DSM)-V of Mental Disorders. Results Higher proportion of psychiatric illness were found significantly among the cases (83.8% vs. 16.2%; p < 0.001) and broad categories of disorders, namely, neurodevelopmental (30.9% vs. 1.5%, p < 0.001), emotional (48.5% vs. 7.4%, p < 0.001) and behavioral disorder (19.1% vs. 7.4%, p = 0.043) compared with controls. There was a significant relationship between psychiatric disorders with the duration of epilepsy of the respondents (p = 0.032). Conclusions This study result showed the significant association of psychiatric disorders with epilepsy among children and adolescent population. Thus, psychiatric disorders should be properly addressed during treatment of epilepsy.

AS3MT Polymorphism: A Risk Factor for Epilepsy Susceptibility and Adverse Drug Reactions to Valproic Acid and Oxcarbazepine Treatment in Children From South China

Epilepsy is a common neurologic disorder characterized by intractable seizures, involving genetic factors. There is a need to develop reliable genetic markers to predict the risk of epilepsy and design effective therapies. Arsenite methyltransferase (AS3MT) catalyzes the biomethylation of arsenic and hence regulates arsenic metabolism. AS3MT variation has been linked to the progression of various diseases including schizophrenia and attention deficit or hyperactivity disorder. Whether genetic polymorphism of AS3MT contributes to epilepsy remains unclear. In this study, we investigated the association of AS3MT gene polymorphism with susceptibility to epilepsy in children from south China. We also explored the effect of AS3MT variation on the safety of antiepileptic drugs. Genotypic analysis for AS3MT rs7085104 was performed using samples from a Chinese cohort of 200 epileptic children and 244 healthy individuals. The results revealed a genetic association of AS3MT rs7085104 with susceptibility to pediatric epilepsy. Mutant homozygous GG genotype exhibited a lower susceptibility to childhood epilepsy than AA genotype. Carriers of AS3MT rs7085104 AA genotype exhibited a higher risk of digestive adverse drug reactions (dADRs) in children when treated with valproic acid (VPA) or oxcarbazepine (OXC). Additionally, bioinformatics analysis identified eight AS3MT target genes related to epilepsy and three AS3MT-associated genes in VPA-related dADRs. The effects of AS3MT on epilepsy might involve multiple targets including CNNM2, CACNB2, TRIM26, MTHFR, GSTM1, CYP17A1, NT5C2, and YBX3. This study reveals that AS3MT may be a new gene contributing to epileptogenesis. Hence, analysis of AS3MT polymorphisms will help to evaluate susceptibility to pediatric epilepsy and drug safety.

Efficacy of Psycho-educational Program on Burden of Caregivers of Children with Epilepsy: A clinical trial

Background: Long-term care of the children with epilepsy and lack of psycho-educational training will lead to caregiver burden. Objectives: The aim of this study was to evaluate the effect of a psycho-educational training program on caregiver burden in families with pediatric epileptic children. Methods: This is a clinical trial study with two groups of experimental and control with three stages of Before, Immediately later, One month after the intervention. The population of the study consisted of family caregivers of children with epilepsy referring to Imam Hossein and Kashani Hospitals in Isfahan, Iran. Seventy families of children (ages 6 - 18years) with epilepsy participated in this study in 2018. The samples were randomly assigned to experimental (35) and control (35) groups using sequential convenience sampling method. The experimental group received a psycho-educational training program in eight sessions (90-minute) in four groups (8 - 9 members), and training was held two sessions a week. The control group participated in three sessions and expressed their problems and experiences. Data were collected using a demographic questionnaire and Zarit Burden Interview (ZBI) that consisted of 22 items and a 5-point Likert scale. Descriptive and inferential statistical methods and SPSS18 were used for data analysis. Results: Before the intervention, there was no statistically significant difference between the two groups of experimental and control in terms of caregiver burden (P = 0.917). However, there was a significant difference between the three time stages in the intervention group after the intervention (P < 0.05; f = 3.511). Meanwhile, the mean score of caregiver burden decreased during the intervention period than before the study (P < 0.05; f = 166.60), while the mean score of caregiver burden did not increase significantly in the control group over time (P = 0.036). Conclusions: The results showed that in a family with school-age epileptic children, appropriate programs and training methods are needed to decrease caregiver burden; so it is necessary to develop and use such programs by the treatment team members.

Assess Self-Management and Adherence to Use Antiepileptic Drugs in Epileptic Pediatric Patients: Cross Sectional Study

Background: No adherence to antiepileptic drugs is a considerable problem for epileptic suffered children and their families. Aim: To determine self-management and adherence to antiepileptic drugs among epileptic children. Study Design: Cross sectional study. Methodology: Present study conducted at Children Complex Hospital, Multan. Sample size was 105. Data was collected after taken the informed consent from the study participants. Institutional approval was taken. Data analyzed through latest version of SPSS 25, including mean, percentage and frequency. Results: Majority 6(81.9%) agreed that doctors/nurses fully explained seizures/epilepsy (diagnosis). Significant correlation was seen between gender and dependent variables (transportation available and medications) with p-value of less than 0.05. Conclusion: This study clearly showed that most patients were well aware about their diagnosis told by doctors and had a knowledge about consequences due to non-adherence with their treatment. Keywords: Adherence, Self-Assessment and Anti-Epileptic Drugs.

Influence of Different Antiepileptic Drugs on Blood Ammonia and Homocysteine Levels in Children with Epilepsy

In this study, we performed a study on 106 children with epilepsy who were treated with sodium valproate (the VPA group, n = 37), oxcarbazepine (the OXC group, n = 34), or levetiracetam (the LEV group, n = 35). In addition, the clinical data of epileptic children who were newly diagnosed in the same period without antiepileptic drug (AED) treatment (the untreated group, n = 35) and normal children who received physical examination in our hospital (the healthy group, n = 35) were selected as controls. We analyzed the efficacy and safety of different AEDs, used blood ammonia and homocysteine levels as the observation indicators, and calculated the incidence of hyperammonemia (VAH) and hyperhomocysteinemia (HHcy) treated with different AEDs. And, based on the effect of epilepsy status on the cognitive function of patients, we also analyzed the effect of different AED treatments on children’s cognitive function. Our results show that sodium valproate, oxcarbazepine, and levetiracetam are all effective in the treatment of children with epilepsy and can be used as the first-line choice of antiepileptic treatment for children with epilepsy. However, compared with sodium valproate, levetiracetam and oxcarbazepine have a lower incidence of adverse drug reactions and do not cause an increase in blood ammonia and Hcy levels, so they have higher safety of drug treatment. In addition, compared with sodium valproate, levetiracetam and oxcarbazepine have better recovery of cognitive function in children with epilepsy and so they have better application value.