Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy

Background Problems on epilepsy do not only depend on the disease itself but also on management and drug regimens. Drug selection is very important to yield optimal treatment effect and to prevent side effects due to long-term therapy. Objective To determine whether there are any different effects of monotherapy of phenytoin, carbamazapine, and valproic acid on pediatric general tonic clonic and partial epilepsy. Methods We conducted a historical cohort study on one month until 18-years old children diagnosed as general tonic clonic or parsial epilepsy treated with phenytoin, carbamazapine, or valproic acid routinely for more than two years in Sardjito Hospital from January 2000 until May 2007. The sample size of each group was 41. The main outcome was the time of 12-month remission, whereas the secondary outcomes were withdrawal from treatment, time to remission, side effects and cure rates. Results Valproic acid increased the possibility to achieve 12-month remission (RR 2.66; 95%CI 1.06;6.65) compared to phenytoin, whereas carbamazapine did not (RR 1.47; 95%CI 0.66;3.28). Survival analysis showed that valproic acid was better than carbamazapine (P=0.042) and phenytoin (P=0.007). There were no significant differences among groups in the result of withdrawal from treatment, time to remission, and cure variables. The side effects of valproic acid seemed less than those of others. Conclusions Valproic acid increases the possibility of 12-month remission compared to carbamazapine and phenytoin as monotherapy in pediatric general tonic clonic and partial epilepsy without increasing side effects. Carbamazapine has similar effects of therapy to phenytoin