Levetiracetam and sulthiame result in reductions in epileptiform discharges in children with benign childhood epilepsy with centrotemporal spikes (BECTS), according to an analysis of a randomized, double-blind trial published in Seizure.
Using data from a randomized, multicenter, controlled trial, investigators collected data on 44 patients with BECTS (characterized by 2 or more seizures in a 6-month period as well as the presence of benign epileptic discharges on electroencephalogram [EEG]) who were randomly assigned to either 30 mg/kg/day levetiracetam (n=21) or 6 mg/kg/day sulthiame (n=21). In the case of adverse events, patients in the levetiracetam and sulthiame groups had the option to reduce doses to 20 mg/kg and 4 mg/kg, respectively. The investigators evaluated EEG findings before and after initiation of therapy.
For both treatment options, the spike-wave-index was reduced. When investigators compared patients with recurrent seizures vs those treated successfully, they found no significant differences between the 2 groups in regard to the number of prestudy seizures (Mann-Whitney U test, P =.511). Despite these findings, there were noticeable differences between the children with recurrent vs no further seizures in terms of EEG characteristics. The investigators found that continual posttreatment epileptiform discharges after 12 weeks were associated with recurrent seizures.
The investigators included no control or placebo group for patients with BECTS, nor did they collect sleep EEGs in all patients, potentially limiting the findings. In addition, the small sample size precludes the ability to make generalized statements about EEG pattern characteristics in the entire pediatric patient population with BECTS.
On the basis of the findings, the investigators suggest that changes in the “EEG response [are] attributable to treatment and not to the natural course of the disease.”
Tacke M, Borggraefe I, Gerstl L, et al. Effects of levetiracetam and sulthiame on EEG in benign epilepsy with centrotemporal spikes: a randomized controlled trial. Seizure. 2018;56:115-120.