title: Higher evening antiepileptic drug dose for nocturnal and early-morning seizures.
abstract: We describe 17 children with nocturnal or early-morning seizures who were switched to a proportionally higher evening dose of antiepileptic drugs and were retrospectively reviewed for seizure outcome and side effects. Of 10 children with unknown etiology, clinical presentation was consistent with nocturnal frontal lobe epilepsy (NFLE) in 5 and benign epilepsy with centrotemporal spikes (BECTS) in 3. After a mean follow-up of 5.3 months, 15 patients were classified as responders; 11 of these became seizure free (5 NFLE, 1 BECTS, 5 with structural lesions) and 4 (2 BECTS, 2 with structural lesions) experienced 75-90% reductions in seizures. Among two nonresponders, seizures in one had failed to resolve with epilepsy surgery. Nine subjects (53%) received monotherapy after dose modification, and none presented with worsening of seizures. Two complained of transient side effects (fatigue/somnolence). Differential dosing led to seizure freedom in 64.7% (11/17) of patients, and 88.2% (15/17) experienced ≥ 50% reductions in seizures.
authors.affiliation: Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: L M F F
authors.initials: LM
authors.lastname: Guilhoto
authors.forename: T
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: M
authors.initials: M
authors.lastname: Vendrame
authors.forename: A
authors.initials: A
authors.lastname: Bergin
authors.forename: B F
authors.initials: BF
authors.lastname: Bourgeois
authors.forename: S V
authors.initials: SV
authors.lastname: Kothare
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002648:Child; D002675:Child, Preschool; D004049:Diethylcarbamazine / Q000008:administration & dosage / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D055870:Drug Chronotherapy; D004569:Electroencephalography; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D000077287:Levetiracetam; D008297:Male; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D012640:Seizures / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D004049:Diethylcarbamazine; D010889:Piracetam