Abstracts

RATIONALE: To evaluate EEG changes in patients with partial seizures who are uncontrolled or not tolerating their current antiepileptic medications and switched to oxcarbamazepine( OXC). OXC is not metabolized by the P450 system, but instead by non-inducible reductase enzymes resulting in fewer drug interactions. The primary active principal is the mono-hydroxy derivative ( MHD). We previously reported ( Sachdeo et al 1984) that when patients were switched from other AEDs to carbamazepine, the resting awake background state as measured by alpha rhythm on the EEG was slowed. It has been our clinical experience that when patients were switched from other AEDs to OXC, they did not show any signs of cognitive slowing. Hence, in theory, when patients switch over from standard antiepileptic medications such as carbamazepine, valproic acid and phenytoin to OXC, the resting awake background rhythm should improve.
METHODS: Patients included in the study were those admitted to Robert Wood Johnson University Hospital from July 2000 to March 2001 for a Video EEG monitering evaluation for their seizures. These patients were uncontrolled or not tolerating their current antiepileptic medications. Patients were switched to OXC monotherapy if previously on one AED, or OXC was used to replace one of the concominat AED. The patients had Video EEG monitering study before anbd after the switch was made and the background activity was evaluated.
RESULTS: Thirty nine patients ( females= 20, males= 19), with a mean age of 38 years, were switched to OXC and maintained on daily doses of 1500-2400 mg. The most common AED that was discontinued for OXC was carbamazepine, and valproic acid and phenytoin represented a smaller percentage. We found that thirty one of the 39 patients ( 79%) showed an improvement in the background alpha rhythm within 24 to 48 hours. The majority of the patients showed that the alpha rhythm increased by 1 Hz after the introduction of OXC and tapering of the carbamazapine or valproate or phenytoin. In some of teh patienbts, the alpha ryhthm improved by 2 Hz. This imrpovement was observed irrespective of geneder or the concominat AED.
CONCLUSIONS: OXC has significant benefits to patients with epileptic seizures with regard to efficacy and tolerability. Furthermore, clinically significant improvement in the background activity on the EEG was observed. Upon switching to OXC these patients reported that they felt better and more alert. These results suggest that OXC may improve the quality of life in patients during long term treatment.
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