Efficacy of felbamate in therapy for partial epilepsy in children.

Thirty children (2 to 17 years of age) with refractory partial seizures received open-label felbamate as an add-on medication to their background antiepileptic drugs. The dose was increased up to a maximum of 45 mg/kg. Compared with baseline seizure activity, there was a 53% decrease in seizure frequency during felbamate therapy; 50% of the patients had more than a 50% decrease in seizure frequency. Patients older than 10 years of age were more likely to have a favorable response. Age correlated positively with felbamate concentrations and negatively with apparent felbamate clearance. Transient weight loss occurred in 57% of the patients; the weight loss was maximal after 12 weeks of initiation of felbamate, and subsided after the twentieth week of treatment. Anorexia and insomnia were reported in 20% and 16% of the patients, respectively. Adverse effects were generally tolerable; felbamate therapy was discontinued because of side effects in only one patient, because of a rash. We conclude that felbamate can be a useful and well-tolerated medication in the treatment of refractory partial epilepsy in children. However, increased apparent clearance of this drug in younger children should be considered in treatment of this age group.

Right common carotid artery ligation in extracorporeal membrane oxygenation.

The effect of right common carotid artery ligation required for arteriovenous extracorporeal membrane oxygenation (ECMO) was investigated in 35 infants. Their neonatal course was reviewed for evidence of right-sided ischemia of the brain, as suggested by the presence of focal seizures, hemiparesis, focal abnormalities on electroencephalography, or infarct or hemorrhage demonstrable on neuroimaging studies. A significant incidence of left focal seizures (9/35) versus right focal seizures (2/35) was noted, suggesting an effect of the carotid ligation on right hemisphere function. Computed tomographic scans (20/35 infants), electroencephalograms (18/35), ultrasound scans (31/35), and neurologic examinations did not reveal an increased incidence of right hemisphere abnormalities. These data suggest that systematic evaluation of the effects of right common carotid ligation should proceed as discussion continues on expanding the use of ECMO.

Evaluation of childhood pseudoseizures using EEG telemetry and video tape monitoring.

Pseudoseizures, clinical events that superficially resemble epileptic attacks but which are not associated with central nervous system paroxysmal activity, are often difficult to differentiate from epileptic seizures. To evaluate the frequency and clinical manifestations of pseudoseizures in children with intractable seizures, children admitted to a Comprehensive Epilepsy Unit received prolonged simultaneous EEG telemetry and video recording. Pseudoseizures occurred in 11 of 53 pediatric patients admitted during the study period. Eight of the 11 patients with pseudoseizures also had documented epileptic seizures. Clinical characteristics of pseudoseizures and epileptic seizures documented by TEEG-VR were compared. Degree and duration of the postictal state, incontinence, combativeness, relationship to stress, and response to anticonvulsant medication were useful differentiating criteria. Pseudoseizures are not unusual in pediatric patients, often occur concurrently with epileptic seizures, and may be difficult to diagnose. However, careful clinical observation may offer clues in differentiating pseudoseizures from epileptic seizures.