Evaluation of the clinical characteristics of antiepileptic drug poisoning in children: A retrospective cross-sectional study

Abstract

Aim: The objective of this study was to delineate the clinical and laboratory manifestations of antiepileptic drug toxicity in pediatric patients, to ascertain the characteristics of intoxication according to age group, and to appraise the management of these patients.

Methods: This retrospective, cross-sectional, descriptive study included 39 pediatric patients aged 1 month to 18 years who presented with antiepileptic drug poisoning to a tertiary pediatric emergency department between January 1, 2014, and December 31, 2017. Demographic characteristics, clinical presentations, laboratory and electrocardiogram findings, antiepileptic drug types and levels, gastrointestinal decontamination practices, hospitalization units, length of stay, and outcomes were recorded. Patients were stratified by poisoning intent (accidental vs. intentional) and age group. Continuous variables were compared using the Mann–Whitney U test, while categorical variables were analyzed using the Pearson chi-square test, continuity correction chi-square test, or Fisher's exact test, as appropriate. A two-sided p-value of ≤0.05 was considered statistically significant.

Results: Twenty-two (56.4%) of the cases were accidental, while 17 (43.6%) were intentional and aimed at self-harm. Twenty-five (64.1%) of the patients had no underlying disease; however, seven (17.9%) had epilepsy, three (7.8%) had epilepsy and intellectual disability, two (5.1%) had bipolar disorder, one (2.6%) had substance addiction, and one (2.6%) had syncope. Among the patients, 18 (46.2%) were poisoned with carbamazepine, 13 (33.3%) with sodium valproate, two (5.1%) with phenobarbital, two (5.1%) with diazepam, one (2.6%) with clonazepam, one (2.6%) with levetiracetam, one (2.6%) with oxcarbazepine, and one (2.6%) with lacosamide. All self-harm cases (n = 17) involved individuals aged ≥ 12 years, and a positive correlation was observed between age and self-harm cases, particularly at age 12 and above (p = 0.001). Girls were more likely to engage in self-harm, whereas boys were more likely to be accidentally poisoned (p = 0.011). Additionally, a significant relationship was observed between self-harm cases and multiple drug ingestion (p = 0.022).

Conclusion: The present study observed a higher frequency of poisoning cases involving carbamazepine and sodium valproate, which are frequently used for epilepsy and non-epileptic indications, compared to other antiepileptic drugs. It is imperative for clinicians to exercise caution and refrain from prescribing these medications in excessive quantities or at elevated doses. It is also noteworthy that symptoms of poisoning may emerge even in cases where the antiepileptic dose is non-toxic or the drug level is low.