COMPARISON OF CARBAMAZEPINE AND LEVETIRACETAM MONOTHERAPY IN CHILDHOOD ROLANDIC EPILEPSY

Öz

Objective: Rolandic epilepsy (RE) is the most common benign focal epilepsy of childhood. While carbamazepine (CBZ) has been widely used in treatment, levetiracetam (LEV) has become one of the first-line options in recent years due to its efficacy and good tolerability. The aim of this study was to compare CBZ and LEV monotherapies in the treatment of RE. Material and Methods: Thirty patients with RE (15 treated with CBZ and 15 with LEV) who were followed at Sütçü İmam University during the last three-year period were retrospectively analyzed. Demographic and clinical characteristics, including age, sex, age at seizure onset, seizure type, and seizure frequency, were evaluated. Changes in seizure frequency after treatment, treatment-related adverse effects, and electroencephalographic (EEG) response were systematically assessed. Results: Of the 30 patients, 20 (66.7%) were male and 10 (33.3%) were female. Twelve patients (80%) in the CBZ group and eight patients (53.3%) in the LEV group were male. The median age at diagnosis was 8.1 years (6.8-8.9), and the median age at treatment initiation was 8.1 years (7.0-8.8). There were no significant differences between the groups regarding sex distribution, age at diagnosis, or age at treatment initiation. No significant difference was found between the two treatment groups in terms of reduction in seizure frequency after treatment. EEG normalization during follow-up was observed in 9 patients (31%), with no significant difference between the groups in EEG normalization frequency or time to normalization. Treatment-related adverse effects were observed in 10 patients (33.3%), with no significant difference between the CBZ and LEV groups. Conclusion: Although no statistically significant differences were found between CBZ and LEV in terms of seizure control, adverse effects, and EEG outcomes, our findings support the use of LEV as an effective monotherapy option in the treatment of childhood RE.

Anahtar Kelimeler

• Rolandic epilepsy
• carbamazepine
• levetiracetam

Çocukluk Çağı Rolandik Epilepsi Hastalarında Karbamazepin ve Levetirasetam Monoterapilerinin Karşılaştırılması

Öz

Amaç: Rolandik epilepsi (RE), çocukluk çağının en sık görülen benign fokal epilepsisidir. Tedavide karbamazepin (CBZ) yaygın kullanılan bir antiepileptikken, levetirasetam (LEV) da son yıllarda etkinliği ve iyi tolere edilebilirliği sebebiyle ilk tercihlerden biri olarak yer almıştır. Çalışmamızın amacı RE tedavisinde CBZ ve LEV monoterapilerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Son üç yılda Sütçü İman Üniversitesinde takip edilen 30 RE hastası (15 CBZ, 15 LEV) retrospektif olarak analiz edildi. Yaş, cinsiyet, nöbet başlangıç yaşı, nöbet tipi ve nöbet sıklığı gibi demografik ve klinik özellikler değerlendirildi. Tedavi sonrası nöbet sıklığındaki değişimler ve yan etkiler, tedaviye elektroensefalografi (EEG) yanıtı sistematik olarak incelendi. Bulgular: Çalışmamızdaki 30 hastanın 20’si erkek (%66,7), 10’u kızdı (%33,3). CBZ grubunun 12’si (%80) erkek, LEV grubunun 8’i (%53,3) erkekti. Grubun tanı yaşı 8,1 (6,8-8,9) yıl [median (%25-75)], tedavi başlama yaşı 8,1 (7,0-8,8) yıldı. Gruplar arasında cinsiyet, tanı ve tedavi başlanma yaşı açısından fark yoktu (sırayla p=0,245; 0,068; 0,085). Tedavi sonrası nöbet sıklığı azalmasında iki ilaç grubu arasında anlamlı fark bulunmadı. Tüm hastaların 9’unda (%31) tedavi süresinde EEG’de normale dönme olduğu görüldü. Gruplar arasında EEG’de düzelme sıklıkları açısından fark yoktu. EEG’nin normale dönme süresi CBZ grubunda 34 (16-36) ay, LEV grubunda 14 (7-33) aydı. EEG düzelme süresi karşılaştırmasında gruplar arasında anlamlı fark görülmedi. Tüm grupta 10 hastada (%33,3) tedaviye bağlı yan etki geliştiği görüldü. Yan etki sıklığı CBZ grubunda 3 (%20), LEV grubunda 7 (%46,7) idi ve aralarında anlamlı fark yoktu (p=0,245). Sonuç: RE tedavisinde nöbet kontrolü, yan etkiler ve EEG bulguları açısından CBZ ve LEV arasında istatistiksel olarak anlamlı bir fark olmamasına karşın, çalışmamız LEV’in etkili bir monoterapötik ajan olarak kullanımını desteklemektedir.

Anahtar Kelimeler

• Rolandik epilepsi
• karbamazepin
• levetirasetam

Kaynakça

1. Mellish LC, Dunkley C, Ferrie CD, Pal DK. Antiepileptic drug treatment of rolandic epilepsy and Panayiotopoulos syndrome: clinical practice survey and clinical trial feasibility. Arch Dis Child. 2015;100:62-67.
2. Dalla Bernardina B, Roger J, Bureau M, et al. Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey; 2005:203.
3. Yalçın D. Guidebook for approach to neurological diseases in children and adolescents. Turkish Neurological Association; 2015:48-55.
4. Vears DF, Tsai MH, Sadleir LG, Grinton BE, Lillywhite LM, Carney PW, Harvey AS. Clinical genetic studies in benign childhood epilepsy with centrotemporal spikes. Epilepsia. 2012;53(2):319-324.
5. Xiong W, Zhou D. Progress in unraveling the genetic etiology of rolandic epilepsy. Seizure. 2017;47:99-105.
6. Amrutkar CV, Riel-Romero RM. Rolandic epilepsy seizure. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
7. Lal D, Reinthaler EM, Schubert J, et al. DEPDC5 mutations in genetic focal epilepsies of childhood. Ann Neurol. 2014;75:788-792.
8. Reinthaler EM, Dejanovic B, Lal D, et al. Rare variants in γ-aminobutyric acid type A receptor genes in rolandic epilepsy and related syndromes. Ann Neurol. 2015;77(6):972-986.

9. Panayiotopoulos CP. The epilepsies: seizures, syndromes and management. Oxfordshire: Bladon Medical Publishing; 2005.
10. Pinton F, Ducot B, Motte J, et al. Cognitive functions in children with benign childhood epilepsy with centrotemporal spikes. Epileptic Disord. 2006;8(1):11-23.
11. Staden U, Isaacs E, Boyd SG, Brandl U, Neville BG. Language dysfunction in children with rolandic epilepsy. Neuropediatrics. 1998;29:242-248.
12. International League Against Epilepsy. Childhood epilepsy with centrotemporal spikes. Accessed January 10, 2025. https://www.ilae.org.
13. Panayiotopoulos CP. Benign childhood focal seizures and related epileptic syndromes. In: Panayiotopoulos CP, ed. The epilepsies: seizures, syndromes and management. 2nd ed. Oxfordshire: Bladon Medical Publishing; 2005:223-269.
14. Panayiotopoulos CP, Michael M, Sanders S, Valeta T, Koutroumanidis M. Benign childhood focal epilepsies: assessment of established and newly recognized syndromes. Brain. 2008;131:2264-2286.
15. Laub MC, Funke R, Kirsch CM, Oberst U. BECTS: comparison of cerebral blood flow imaging, neuropsychological testing and long-term EEG findings. Epilepsy Res Suppl. 1992;6:95-98.
16. Uran N, Arslanoğlu S, Şentürk H. Rolandik epilepsili ellibir olgunun değerlendirilmesi. Türkiye Klinikleri Pediatri Dergisi. 2000;9:28-31.
17. Colamaria V, Sgro V, Caraballo R, et al. Status epilepticus in benign rolandic epilepsy manifesting as anterior operculum syndrome. Epilepsia. 1991;32(3):329-334.
18. Haslam RHA. Seizures in childhood. In: Behrman RE, Kliegman RM, Arvin AM, Nelson WE, eds. Nelson textbook of pediatrics. 15th ed. Philadelphia: WB Saunders; 1996:1686-1692.
19. Ahadi P, Nasiri J, Ghazavi MR, Mosavian T, Mansouri V. A comparative study on the efficacy of levetiracetam and carbamazepine in the treatment of rolandic seizures in children. J Res Pharm Pract. 2020;9:65-70.
20. Kanemura H, Sano F, Ohyama T, Aihara M. Efficacy of levetiracetam for reducing rolandic discharges in comparison with carbamazepine and valproate sodium in rolandic epilepsy. Seizure. 2018;62:79-83.
21. Xiao F, An D, Deng H, et al. Evaluation of levetiracetam and valproic acid as low-dose monotherapies for children with typical benign childhood epilepsy with centrotemporal spikes. Seizure. 2014;23:756-761.
22. Asadi-Pooya AA, Forouzesh M, Eidi H, Mirzaghafour SE. Levetiracetam versus carbamazepine in treatment of rolandic epilepsy. Epilepsy Behav. 2019;94:1-8.