Pharmacokinetic considerations in the treatment of childhood epilepsy

Jamie T. Gilman, Michael Duchowny, Ana Campo

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Organogenesis throughout childhood affects almost every aspect of pediatric pharmacotherapy. The antiepileptic drugs (AEDs) are particularly impacted since most elimination rates are diminished for the first 6 months of infancy, but quickly attain and supersede adult values. When children enter a hypermetabolic stage, large doses of AEDs may be necessary to maintain effective serum concentrations. Medication noncompliance is frequently confused as hypermetabolism, since both present with low serum drug concentrations. Amazingly, noncompliance among children with chronic illness approaches a similar incidence to that reported in the adult population. It is obviously important to include this in the differential diagnosis of the etiology of subtherapeutic serum AED concentrations. Maturational differences also affect gastrointestinal drug absorption. Intestinal transit time and absorptive surface area are both diminished in young children. Drug delivery systems suitable in adults may not deliver the total dosage in children. Differences in the composition of body compartments and protein binding can alter the volume of drug distribution and, consequently, serum concentrations. In addition to pathophysiologic changes, there is evidence to suggest differences between a mature and immature brain. These differences include quantitative and qualitative responses to neurotransmitters. Hence, it is understandable why seizure semiology is different in children compared with adults. This constellation of factors contributes to the challenges of caring for children with epilepsy.

Original languageEnglish
Pages (from-to)267-277
Number of pages11
JournalPediatric Drugs
Volume5
Issue number4
StatePublished - May 1 2003

Fingerprint

Epilepsy
Pharmacokinetics
Anticonvulsants
Serum
Therapeutics
Gastrointestinal Agents
Medication Adherence
Organogenesis
Drug Delivery Systems
Body Composition
Protein Binding
Pharmaceutical Preparations
Neurotransmitter Agents
Seizures
Differential Diagnosis
Chronic Disease
Pediatrics
Drug Therapy
Incidence
Brain

ASJC Scopus subject areas

  • Pharmacology
  • Pediatrics, Perinatology, and Child Health

Cite this

Pharmacokinetic considerations in the treatment of childhood epilepsy. / Gilman, Jamie T.; Duchowny, Michael; Campo, Ana.

In: Pediatric Drugs, Vol. 5, No. 4, 01.05.2003, p. 267-277.

Research output: Contribution to journalArticle

Gilman, Jamie T. ; Duchowny, Michael ; Campo, Ana. / Pharmacokinetic considerations in the treatment of childhood epilepsy. In: Pediatric Drugs. 2003 ; Vol. 5, No. 4. pp. 267-277.
@article{2446dbdf0c1840b08db0f17eea8e2e5e,
title = "Pharmacokinetic considerations in the treatment of childhood epilepsy",
abstract = "Organogenesis throughout childhood affects almost every aspect of pediatric pharmacotherapy. The antiepileptic drugs (AEDs) are particularly impacted since most elimination rates are diminished for the first 6 months of infancy, but quickly attain and supersede adult values. When children enter a hypermetabolic stage, large doses of AEDs may be necessary to maintain effective serum concentrations. Medication noncompliance is frequently confused as hypermetabolism, since both present with low serum drug concentrations. Amazingly, noncompliance among children with chronic illness approaches a similar incidence to that reported in the adult population. It is obviously important to include this in the differential diagnosis of the etiology of subtherapeutic serum AED concentrations. Maturational differences also affect gastrointestinal drug absorption. Intestinal transit time and absorptive surface area are both diminished in young children. Drug delivery systems suitable in adults may not deliver the total dosage in children. Differences in the composition of body compartments and protein binding can alter the volume of drug distribution and, consequently, serum concentrations. In addition to pathophysiologic changes, there is evidence to suggest differences between a mature and immature brain. These differences include quantitative and qualitative responses to neurotransmitters. Hence, it is understandable why seizure semiology is different in children compared with adults. This constellation of factors contributes to the challenges of caring for children with epilepsy.",
author = "Gilman, {Jamie T.} and Michael Duchowny and Ana Campo",
year = "2003",
month = "5",
day = "1",
language = "English",
volume = "5",
pages = "267--277",
journal = "Pediatric Drugs",
issn = "1174-5878",
publisher = "Adis International Ltd",
number = "4",

}

TY - JOUR

T1 - Pharmacokinetic considerations in the treatment of childhood epilepsy

AU - Gilman, Jamie T.

AU - Duchowny, Michael

AU - Campo, Ana

PY - 2003/5/1

Y1 - 2003/5/1

N2 - Organogenesis throughout childhood affects almost every aspect of pediatric pharmacotherapy. The antiepileptic drugs (AEDs) are particularly impacted since most elimination rates are diminished for the first 6 months of infancy, but quickly attain and supersede adult values. When children enter a hypermetabolic stage, large doses of AEDs may be necessary to maintain effective serum concentrations. Medication noncompliance is frequently confused as hypermetabolism, since both present with low serum drug concentrations. Amazingly, noncompliance among children with chronic illness approaches a similar incidence to that reported in the adult population. It is obviously important to include this in the differential diagnosis of the etiology of subtherapeutic serum AED concentrations. Maturational differences also affect gastrointestinal drug absorption. Intestinal transit time and absorptive surface area are both diminished in young children. Drug delivery systems suitable in adults may not deliver the total dosage in children. Differences in the composition of body compartments and protein binding can alter the volume of drug distribution and, consequently, serum concentrations. In addition to pathophysiologic changes, there is evidence to suggest differences between a mature and immature brain. These differences include quantitative and qualitative responses to neurotransmitters. Hence, it is understandable why seizure semiology is different in children compared with adults. This constellation of factors contributes to the challenges of caring for children with epilepsy.

AB - Organogenesis throughout childhood affects almost every aspect of pediatric pharmacotherapy. The antiepileptic drugs (AEDs) are particularly impacted since most elimination rates are diminished for the first 6 months of infancy, but quickly attain and supersede adult values. When children enter a hypermetabolic stage, large doses of AEDs may be necessary to maintain effective serum concentrations. Medication noncompliance is frequently confused as hypermetabolism, since both present with low serum drug concentrations. Amazingly, noncompliance among children with chronic illness approaches a similar incidence to that reported in the adult population. It is obviously important to include this in the differential diagnosis of the etiology of subtherapeutic serum AED concentrations. Maturational differences also affect gastrointestinal drug absorption. Intestinal transit time and absorptive surface area are both diminished in young children. Drug delivery systems suitable in adults may not deliver the total dosage in children. Differences in the composition of body compartments and protein binding can alter the volume of drug distribution and, consequently, serum concentrations. In addition to pathophysiologic changes, there is evidence to suggest differences between a mature and immature brain. These differences include quantitative and qualitative responses to neurotransmitters. Hence, it is understandable why seizure semiology is different in children compared with adults. This constellation of factors contributes to the challenges of caring for children with epilepsy.

UR - http://www.scopus.com/inward/record.url?scp=0037266072&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037266072&partnerID=8YFLogxK

M3 - Article

VL - 5

SP - 267

EP - 277

JO - Pediatric Drugs

JF - Pediatric Drugs

SN - 1174-5878

IS - 4

ER -