Oxcarbazepine Monotherapy in Children with Benign Epilepsy with Centrotemporal Spikes Improves Quality of Life
Benign epilepsy with centrotemporal spikes (BECTS) is the most common type of childhood idiopathic focal epilepsy, typically manifesting between the ages of 6 and 10 years. It accounts for up to 16% of all childhood epilepsy cases. While seizures in BECTS are often easily controlled and tend to remit before puberty, the condition is associated with pervasive cognitive deficits and behavioral problems. These include impairments in language function, memory, executive function, attention, and psychosocial difficulties. Given that children with BECTS are in a critical stage of developing social strategies and acquiring new skills, it is essential to select anti-epileptic drugs (AEDs) that not only control seizures but also avoid further impairing cognitive and psychosocial functions. Moreover, improving the overall quality of life (QOL) for these children is a key goal.
Oxcarbazepine (OXC), a ketoanalogue of carbamazepine, has a favorable pharmacokinetic and tolerability profile. Previous studies have demonstrated its safety and efficacy in controlling seizures in pediatric epilepsy, with minimal adverse effects. However, its impact on cognitive and psychosocial functions in children with BECTS has not been thoroughly investigated. This study aimed to evaluate the effects of OXC monotherapy on neuropsychologic profiles and quality of life in children with BECTS in China.
The study recruited 31 children aged 6 to 12 years who were newly diagnosed with BECTS. The inclusion criteria required that participants have typical clinical and electroencephalogram (EEG) features of BECTS, experience at least two seizures in the past three months, and be drug-naive. Exclusion criteria included previous exposure to AEDs, systemic diseases, structural brain abnormalities, or an inability to complete the tasks independently. OXC was administered at an initial dosage of 5 to 10 mg/kg/day, which was gradually increased to 30 mg/kg/day based on clinical requirements.
A comprehensive psychometric assessment was conducted before and after OXC monotherapy to evaluate cognitive function, mood disorders, and quality of life. The assessment battery included ten cognitive tests: choice reaction time, Raven’s progressive matrices, visual tracing, number magnitude comparison, mental rotation, simple subtraction, word semantics, paired associative learning (language and number), and number serial completion. These tests assessed various cognitive abilities, including processing speed, spatial skills, calculation, language ability, intelligence, visual attention, memory, and learning ability. Additionally, the Depression Self-Rating Scale for Children and the Screen for Child Anxiety Related Emotional Disorders were used to evaluate mood disorders. The Quality of Life in Epilepsy-31 (QOLIE-31) scale, adapted for Chinese children, was employed to assess quality of life across seven domains: self-worry about seizures, social function, emotional status, cognition, energy/vitality, health perceptions, and general life satisfaction.
Thirty children completed the study, and the results revealed significant improvements in several cognitive test scores after OXC treatment. Specifically, visual tracing, paired associative learning (language and number), word semantics, and simple subtraction showed statistically significant improvements. These tasks require comprehensive cognitive abilities such as visual function, executive function, and attention, indicating that OXC monotherapy does not impair these functions and may even provide mild protective effects.
In terms of mood disorders, no significant differences were observed in depression and anxiety scores before and after OXC treatment. This suggests that OXC does not impose a mood burden on children with BECTS, which is particularly important given the risk of depressive symptoms associated with other AEDs such as barbiturates, vigabatrin, and topiramate. Even levetiracetam, a commonly used AED in childhood epilepsy, has been linked to an increased risk of depression. The absence of mood-related side effects with OXC makes it a favorable choice for children who are in a critical developmental stage.
The most notable findings of the study were the improvements in quality of life after OXC treatment. Significant enhancements were observed in the QOLIE-emotion, QOLIE-social, and QOLIE-total scores. These improvements indicate that OXC positively impacts children’s perception of their quality of life, particularly in terms of emotional well-being and social functioning. The QOLIE-emotion domain, which assesses emotional status, showed marked improvement, suggesting that OXC may have mood-stabilizing benefits. This is consistent with previous studies that have highlighted OXC’s potential as a mood stabilizer in patients with bipolar disorder.
The QOLIE-social domain, which evaluates social function, also showed significant improvement, reflecting better social interactions and relationships in children with BECTS. The overall QOLIE-total score, which encompasses all seven domains of quality of life, demonstrated a significant increase, indicating that OXC monotherapy enhances the overall well-being of children with BECTS. This is particularly important given the complex and chronic nature of epilepsy, which can significantly affect a child’s happiness and life satisfaction.
The study also addressed the broader implications of treating BECTS. While controlling seizures is a primary goal, the cognitive and behavioral issues associated with BECTS are often the most intrusive manifestations of the condition. These issues can persist even after seizure remission, affecting academic performance, social interactions, and overall development. The findings of this study suggest that OXC not only effectively controls seizures but also supports cognitive and psychosocial functions, making it an optimal treatment choice for children with BECTS.
In conclusion, OXC monotherapy is safe and effective for children with BECTS, with no detrimental effects on neuropsychologic functions or mood. It provides mild protective effects on cognitive abilities and significantly improves the quality of life, particularly in terms of emotional well-being and social functioning. These benefits make OXC a favorable AED for children with BECTS, supporting their overall development and well-being during a critical stage of life.
doi.org/10.1097/CM9.0000000000000925
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