The efficacy of oxcarbazepine monotherapy in 60 children and adolescents (aged 6 months to 17.8 years; mean age 8.2 yrs) with partial onset epilepsy was evaluated by retrospective chart review in a study at St Christopher’s Hospital for Children, Philadelphia, PA. Dosage ranged from 6 to 71 mg/kg/day (mean 26.3 mg/kg/day). The mean dose varied with age, higher doses were required in younger patients; in patients <4 years, the mean dose was 33.1 mg/kg/day; 8-12 years, 25 mg/kg/day. Duration of therapy was 3 months to 8 years (mean duration 16.7 months). Reduction in seizure frequency was >50% in 51 (85%) patients, and complete control was achieved in 25 (42%). Adverse events occurred in 10 (16.7%) and included drowsiness, aggressive behavior, ataxia, dizziness, diplopia, and leg cramps. None had hyponatremia or skin rash. Of 24 patients switched from carbamazepine to oxcarbazepine because of toxic effects or poor seizure control, 79% had >50% seizure reduction, and 37.5% became seizure-free. Serum levels were not determined. [1]

COMMENT. Oxcarbazepine monotherapy, a keto analog of carbamazepine, is effective and without serious side effect in children and adolescents with partial epilepsy. It is approved as monotherapy in children >4 years old and as adjunctive therapy in children >2 years old (in Europe, for >6 year-olds). The inverse relation between dose and age is a reflection of a more rapid clearance of oxcarbazepine in younger patients.