Kids and Adverse Effects of AEDs: No More Hide and Seek

A new tool for measuring adverse effects associated with antiepileptic drugs in children promises to produce more reliable results for a broader range of patients.

More than 325,000 children in the United States need antiepileptic drugs (AEDs) for seizure control, but adverse effects limit the range of viable options. Until recently, the only tool available to measure side effects of AEDs was the Hague Scale, which was targeted to patients with more severe forms of epilepsy and tested only in small populations.

Now, in an article published online on August 8, 2012, in Neurology, researchers have introduced a new tool, the Pediatric Epilepsy Side Effects Questionnaire (PESQ). It can be used reliably in a broader population of children because the researchers used a diverse patient population diagnosed with many types of epilepsy, undergoing various treatment durations, and taking a large selection of AEDs.

"Assessment of side effects is challenging due to the use of different descriptive terms and the difficulty in determining their severity in an objective way," the researchers write. "The PESQ addresses many of these issues: it standardizes terminology, provides an objective measurement, and quantifies side effects that can be followed longitudinally."

The PESQ includes 19 items and yields a total score as well as scores on each of 5 subscales: behavioral, cognitive, general neurological, motor, and weight. These represent AEDs’ most common side effects, which are also the side effects patients and their families worry about most. Tested in 495 children, the questionnaire is easy for children to understand, and helps clinicians identify adverse effects early so they can make clinical changes. Early intervention may help increase adherence and decrease morbidity.

In constructing the PESQ, the researchers found several noteworthy trends:

• The number of adverse effects reported increased as the number of prescribed drugs increased, with all 5 subscale scores significantly affected.
• Girls and older children reported more general neurological and weight side effects compared with boys, possibly reflecting societal pressure to be thin and teenage angst about weight and image.

The researchers also found that children receiving valproic acid had significantly higher weight scores than those given carbamazepine.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.