INTRODUCTION:

Epilepsy is a disorder of the central nervous system which can be identified by unprovoked and recurrent seizures.^1–3 The prevalence of pediatric epilepsy shows significant variation across countries, with rates ranging 4-6 per 1000 children. Based on the data of World Health Organization (WHO), the incidence rate is approximately 50 per 100,000 population in the first-world countries, whereas in third-world countries, it is significantly greater with 100-190 per 100,000 population.^2,4 In Indonesia, it is estimated that there are between 700,000 to 1.4 million incidences, with approximately 70,000 new incidences annually, 40%-50% of which occur in children.² Meanwhile, an epidemiological study reported developed countries’ pediatric epilepsy incidence ranging from 33.3 to 82 cases per 100,000 annually. Prevalence rates in developing countries tend to be higher than those in developed nations.⁵

The practical definition of epilepsy as stated by the International League Against Epilepsy (ILAE) in 2014, epilepsy can be diagnosed after a minimum of two unprovoked (or reflex) episodes >24hours apart (traditional definition), or after one unprovoked (or reflex) episode with a probability of subsequent episodes equivalent to the risk of generalized recurrence (at least 60%) following two unprovoked episodes within the next 10 years, and diagnosis of an epilepsy syndrome.⁶ According to ILAE 2017, the diagnosis of epilepsy is classified into 3 levels, starting with epilepsy type, epilepsy syndrome, and seizure type. The types of epilepsy are classified as focal, generalized, combined of focal and generalized, and epilepsy of unidentified origin.⁷

Successful treatment of epilepsy influenced by many variables, like the type of epilepsy, instigator, and selection of antiseizure medications (ASMs).^8–10 Most children with new-onset epilepsy, especially those with idiopathic generalized epilepsy, can become seizure-free with appropriate ASMs.^11,12 The first generation of ASMs, commonly referred as traditional ASMs, represented a major breakthrough in the treatment of epilepsy.^12–16Pediatric epilepsy patients receiving first-generation ASMs therapy may also have characteristics that influence their response to treatment.^13,17–19 Some of them may show good tolerance to these drugs, with epileptic seizures being well controlled with appropriate dosing. However, some patients may experience significant side effects from the drugs, such as gastrointestinal disturbances, cognitive impairment or behavioural disturbances.^20–22 Factors such as medication adherence and dose adjustment can also affect the effectiveness of therapy in pediatric epilepsy patients.²³ Therefore, it is important to understand patient characteristics holistically, including clinical aspects, genetics, and response to treatment, to develop an optimal treatment plan to manage pediatric epilepsy with first-generation ASMs therapy.

MATERIALS AND METHODS:

Data collection in the study was conducted using cross-sectional recording methods to identify the characteristics of pediatric epilepsy patients receiving first-generation ASMs therapy during outpatient visits at Dr. Wahidin Sudirohusodo Hospital, focusing on those with a complete history of treatment and clinical condition. The sampling method also involves collecting data from the patient's well-documented medical database, including patients’ family history, age, type of epilepsy, attacks frequency, and response to first-generation ASMs therapy. In addition, this method may also involve interviews with the patient's parents or guardians to obtain additional information on other aspects relevant to the characteristics of pediatric epilepsy patients. Thus, this sampling method is designed to obtain a comprehensive and representative dataset that can support the analysis of the characteristics of pediatric epilepsy patients receiving first-generation ASMs therapy.

Data for this study, which evaluates the clinical features, treatment outcomes of first-generation ASMs, and factors influencing treatment response in pediatric epilepsy patients, were input into Microsoft Excel 2021 for organization and subsequently analyzed with SPSS version 26. Descriptive statistics were applied via univariate analysis to present the frequency distribution of key clinical variables. To examine relationships between clinical factors and treatment outcomes, bivariate examination with the chi-square analysis was conducted. We determine odds ratios with 95% confidence intervals. The results considered statistically relevant if the p value is ≤ 0.05

RESULT:

The data presented showed a comprehensive overview of the characteristics of pediatric epilepsy patients receiving first-generation ASMs therapy. Firstly, the data show a nearly equal gender distribution among the patients, with little difference between the number of males and females. The age data reveal that the majority of patients are between 6 months and 7 years old, aligning with the fact that pediatric epilepsy is more common in younger children. Most of the seizure types were generalized seizures, which is typical in pediatric epilepsy cases. The duration of the majority of seizures ranged from 1 to 5 minutes, and most patients experienced seizures more than three times a day, highlighting the severity of the condition in many cases. (Table 1).

Furthermore, the length of time patients received ASMs reflects the relatively long treatment and demonstrates the challenges in the management of pediatric epilepsy. The controlled response to treatment in the majority of patients was a positive indication of the effectiveness of therapy. although a small proportion still had uncontrolled seizures. Loss of consciousness during seizures is common. as the nature of epilepsy often results in decreased consciousness. (Table 1).

The presence of seizure in family history and neurological deficits in a minority of patients highlights the importance of genetic factors and additional complications in certain cases. Additionally, the fact that the majority of patients received monotherapy suggests that most cases can be effectively managed with a single type of ASMs. However, the presence of patients receiving polytherapy suggests that some cases may require a more complex treatment approach. The EEG results show the presence of oscillations in a minority of patients provided additional information about the electrical activity of the brain during epileptic seizures. Overall, these data presents valuable insight into the characteristics of children with epilepsy receiving first-generation ASMs, which potentially contributing to more effective disease management. (Table 1).

Table 1. Characteristics of Patients

Characteristics	Epilepsy (n=60)	%
Sex
Male	30	50%
Female	30	50%
Age
6 months to ≤ 7 years	38	63.33%
>7 years to ≤ 12 years	8	13.33%
>12 years	14	23.33%
Seizure type
Generalized	45	75%
Focal	15	25%
Seizure duration
<1 minute	11	18.33%
1-5 minutes	45	75%
>5 minutes	4	6.67%
Seizure frequency
≤ 3 times a day	25	41.67%
> 3 times a day	35	58.33%
Duration of antiseizure medications (ASMs)
≤ 6 months	16	26.67%
> 6 months	44	73.33%
Response to Medication
Controlled	33	55%
Uncontrolled	27	45%
Consciousness
Conscious	24	40%
Unconscious	36	60%
Family history of seizures
Yes	15	25%
No	45	75%
Neurological deficit
Yes	14	23.33%
No	46	76.67%
Quantity of antiseizure medication
Monotherapy	53	88.33%
Polytherapy	7	11.67%
EEG results
With epileptiform discharge	11	18.3%
No epileptiform discharge	49	81.6%

In this study, factors influencing response to treatment in pediatric epilepsy patients were thoroughly explored. The results indicate that although patient age is an important factor in epilepsy treatment, it was not significantly associated with treatment response (p = 0.47). Similarly, the type of seizure also did not have a significant association with response to treatment (p = 0.11). However, the duration of ASMs did not significantly affect treatment response (p = 0.24). Interestingly, the association between the presence of neurological deficits in patients and response to treatment (p = 0.00) was found to be significant, suggesting the need for further monitoring and intervention in patients with this additional condition. Furthermore, the number of therapies received by the patient showed no significant influence on response to treatment (p = 0.22). (Table 2).

Table 2. Comparison of Patient Characteristics and Treatment Response

Characteristics		Treatment Response		P-value
Characteristics		Controlled	Uncontrolled	P-value
Age	6 months to ≤ 7 years	21	17	0.47
	>7 years to ≤ 12 years	3	5
	>12 years	9	5
Seizure Type	Generalized	27	18	0.14
Seizure Type	Focal	6	9	0.14
Duration of Medication	≤ 6 months	11	5	0.24
Duration of Medication	>6 months	22	22	0.24
Neurological Deficit	Yes	1	13	0.00
Neurological Deficit	No	32	14	0.00
Quantity of ASMs (Therapy)	Monotherapy	31	22	0.22
Quantity of ASMs (Therapy)	Polytherapy	2	5	0.22

DISCUSSION:

Several studies discuss predictors of therapeutic response in patients with epilepsy. A study by Ghorfani et al.¹⁰ reported the beginning of epilepsy before the age of 6 years was one of the predictors of controlled seizures. along with other factors such as normal IQ (or normal thinking), no previous history of epilepsy, and no seizures in the first week of treatment. Another study by Namusisi et al.²⁴ explained that adolescents have poorer seizure control than younger age groups. These findings were different with our study's results on the relationship between age and treatment outcomes.

Another research by Ahmad et al.²⁵ describes the relationship between giving monotherapy to epilepsy patients compared to polytherapy providing well-controlled seizure outcomes (good control in this study is defined if they have at least a 50% reduction in the number of seizures in this one-year study period compared to the previous year), with a significant difference (p<0.001). In line with research by Poudel et al.²⁶ who explained that the most influential factor in poor seizure control was polytherapy, and research by Adal et al.²⁷ who associated polytherapy with poor seizure control significantly. The study by Chen et al.²⁸ explained their findings in more detail that epilepsy remain uncontrolled after the first ASMs therapy had 1.73 times more likely to be unresponsive to each following treatment protocol. Our study is in line with this study as patients who received monotherapy were more in the controlled seizure group, although not significantly so.

Another study on 320 patients with epilepsy also found that a treatment duration of less than 2 years was associated with poor seizure control. This is not in line with our study which could be due to a different follow-up period where our study took a cutoff point of 6 months.²⁹

Regarding seizure type, several researches have shown a prominent impact of seizure type on prognosis. According to a study in Rochester, Minnesota, patients suffering from generalized tonic-clonic seizures and absence seizures had an 85% and 80% likelihood of attaining remission, respectively, while those who have complex partial seizures only have 65% likelihood.³⁰

Regarding the finding of an association of neurological deficits with seizure control outcomes. This is also aligned with a study in Rochester, Minnesota, which discovered that patients with epilepsy due to brain injury considered to have occurred in the perinatal period, which manifest as intellectual and physical disabilities, only have 46% chance of attaining controlled seizure. In contrast, patients with idiopathic epilepsy and those with epilepsy resulting from lesions acquired after birth have a 74% chance. Initial clinical-based studies in adults also confirmed this idea. The following studies, particularly in children, reported that neurological deficits, specifically those related to cognitive dysfunction, indicate a worse prognosis.³⁰

CONCLUSION:

This study concludes that while age, seizure type, ASMs duration, and the number of therapies does not significantly impact treatment response in pediatric epilepsy, the presence of neurological deficits is a significant factor, indicating the need for targeted monitoring and intervention in affected children.

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Received on 31.10.2024 Revised on 25.02.2025

Accepted on 06.05.2025 Published on 01.10.2025

Available online from October 04, 2025

Research J. Pharmacy and Technology. 2025;18(10):4955-4959.

DOI: 10.52711/0974-360X.2025.00716

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