An Investigation Of The Efficacy Of Initial Treatment With Different Antiepileptic Drugs In Children With Self-limiting Epilepsy With Central-temporal Spikes

ObjectiveIn this study,the clinical efficacy of initial monotherapy with levetiracetam(LEV)and valproic acid(VPA)in children with Se If-limited epilepsy with centrotemporal spikes(Se LECTS)was investigated.A retrospective controlled study was conducted to examine the clinical efficacy and EEG changes in children with Se LECTS,and to investigate the risk factors affecting the efficacy of initial monotherapy in order to provide an evidence-based basis for the clinical management of children with Se LECTS.MethodsA total of 67 children with Se LECTS who met the inclusion and exclusion criteria were retrospectively analyzed from 2019.1 to 2022.9 in the inpatient or outpatient department of the Department of Neurology,Shenyang Children’s Hospital.Clinical data(gender,age,duration of illness,history of febrile convulsions,family history of convulsions,seizure data,EEG data)were collected from all children with Se LECTS.The children were divided into three groups according to treatment status: the LEV monotherapy group(LEV group),the VPA monotherapy group(VPA group)and the group without Anti-seizure medications(ASMs)(untreated group).There were no statistically significant differences between the untreated group and the LEV and VPA groups in terms of gender,age,duration of illness,number of seizures and discharge index.The number of seizures,video-electroencephalogram(VEEG)and adverse effects of the treatment group were recorded in detail for all Se LECTS children within six months of enrollment.The children in the treatment group were divided into seizure control group and poor control group according to whether they still had seizures after treatment.The factors with statistically significant differences were then included in the logistic regression analysis.Results1.Analysis and evaluation of clinical seizures: clinical seizure control rate in the LEV group was 62.96%(17/27),with an overall remission rate of 88.89%(24/27);control rate in the VPA group was 60.00%(15/25),with an overall remission rate of84.00%(21/25);control rate in the untreated group was 40.00%(6/15),with an overall remission rate of 66.67%(10/15)./The differences in clinical seizure control rate(χ2=2.25,P>0.05)and total remission rate(χ2 =3.12,P>0.05)were not statistically significant when comparing the 3 groups.2.Evaluation of EEG discharge index change analysis: EEG discharge control rate in the LEV group was 22.22%(6/27),with an overall improvement rate of 70.37%(19/27);VPA control rate was 16.00%(4/25),with an overall improvement rate of64.00%(16/25);control rate in the untreated group was 6.67%(1/15),with an overall improvement rate of 20.00%(3/ 15);there was no significant difference in the control rate of EEG discharge between the three groups(χ2 =1.54,P>0.05);however,there was a significant difference between the total improvement rate of EEG discharge index(χ2=10.83,P<0.05).The total improvement rate of EEG discharge index was significantly higher in the LEV and VPA groups compared to the untreated group,and the difference was statistically significant(P < 0.0167),but its difference was not statistically significant between the LEV and VPA groups(P > 0.0167).3.Evaluation of drug safety events: The incidence of adverse reactions among children in the LEV group was 11.11%(3/27),including one case each of abnormal mood,drowsiness and hyponatremia;the incidence of adverse reactions among children in the VPA group was 36.00%(9/25),including two cases each of abnormal liver function,drowsiness and gastrointestinal reactions,and one case each of thrombocytopenia,weakness and weight gain.The difference was statistically significant when comparing the incidence of adverse reactions between the 2 groups(χ2=4.53,P<0.05).4.Low age onset(OR=1.225,95% CI 1.022-1.469,P<0.05),frequent episodes(OR=0.039,95% CI 0.002-0.815,P<0.05)and high discharge index(OR=0.849,95%CI 0.729-0.989,P<0.05)were the initial LEV,VPA There was no statistically significant correlation between gender,duration of disease,side of discharge,period of discharge and clinical episode type and outcome(P>0.05).Conclusions1.There was no significant difference in seizure control and remission in the short term in children with Se LECTS treated with initial monotherapy with LEV and VPA compared to children with Se LECTS not treated with antiepileptic drugs.and early treatment is not recommended for children diagnosed with this disease if seizures are rare.2.Initial monotherapy with LEV and VPA significantly improved the EEG discharge indices in children with Se LECTS,and the effect of both on EEG improvement was comparable,whereas there was no significant improvement in the EEG discharge indices in children with Se LECTS not treated with antiepileptic drugs.3.Levetiracetam was less adverse and better tolerated than sodium valproate.4.Low age onset(≤5 years),frequent seizures(≥3 seizures before treatment)and high discharge index(≥50%)may be independent risk factors for poor outcome of initial monotherapy with LEV and VPA in children with Se LECTS,and clinicians should be aware of these risk factors in assessing the child’s condition and adjusting the antiepileptic treatment medication in a timely manner.