Use of zonisamide in children with cerebral palsy and epilepsy: literature review and own data
https://doi.org/10.17650/2073-8803-2025-20-2-23-33
Abstract
Cerebral palsy (CP) is often combined with epilepsy and epileptiform activity on the electroencephalogram. Uncontrolled epileptic seizures in CP limit rehabilitation opportunities, which aggravates motor and cognitive deficits. The main epileptic syndromes in children with CP are focal epilepsy with structural changes in the brain and benign epileptiform patterns of childhood on the electroencephalogram and structural focal epilepsy; the main types of seizures are focal motor, bilateral tonic-clonic, febrile-provoked seizures may also be observed. In CP, seizures often have a status course, can last more than 30 minutes and are stopped only in the intensive care unit. One patient may have several types of seizures, including epileptic status. Even in the absence of seizures, changes in the electroencephalogram are detected both in the form of regional epileptiform activity, often in the structure of regional prolonged slowing, and in the form of benign epileptiform patterns of childhood. Valproates, topiramate, levetiracetam, zonisamide, lamotrigine, ethosuximide, perampanel, vigabatrin, sultiame, rufinamide are recommended in the treatment of epilepsy in CP. We present a literature review and analysis of our own data on the use of zonisamide in patients with epilepsy and CP aged 6 to 17 years.
Keywords
About the Authors
M. Yu. BobylovaRussian Federation
Mariya Yuryevna Bobylova
9 Akad. Anokhina St., Moscow 119571
K. S. Borovikov
Russian Federation
9 Akad. Anokhina St., Moscow 119571
References
1. Abusueva B.A., Askevova M.A., Shanavazova M.D. et al. Comorbidity of cerebral palsy and epilepsy with autism in children. Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2023;18(2–3):14–21. (In Russ.). DOI: 10.17650/2073-8803-2023-18-2-3-14-21
2. Albitsky V.Yu., Antonova E.V., Baranov A.A. et al. Main trends in the health of children in Russia. Moscow: Scientific Center for Children’s Health, Russian Academy of Medical Sciences, 2011. 116 p. (In Russ.)
3. Batysheva T.T. Features of rehabilitation of movement disorders in children with cerebral palsy and concomitant epileptic seizures. Methodical recommendations. Moscow, 2019. 44 p. (In Russ.).
4. Badalyan O.L., Trepilets V.M., Trepilets S.V. Clinical experience with zonisamide in structural focal epilepsy in children with cerebral palsy. Zhurnal nevrologii i psikhiatrii = Journal of Neurology and Psychiatry 2018;10(2):90–7. (In Russ.). DOI: 10.17116/jnevro201811810290
5. Belousova E.D. Risk factors, treatment tactics and prognosis of convulsive syndrome and epilepsy in children with cerebral palsy. Abstract of a doctor of medicine dissertation. Moscow, 2004. 48 p. (In Russ.).
6. Bobylova M.Yu., Shanavazova M.D., Askevova M.A., Abusueva B.A. The influence of rehabilitation treatment on the results of electroencephalography and the course of epilepsy in children with cerebral palsy. Epilepsiya i paroksizmalnye sostoyaniya = Epilepsy and Paroxysmal Conditions 2020;12(4):197–204. (In Russ.). DOI: 10.17749/2077-8333/epi.par.con.2020.040
7. Borovikov K.S. Focal epilepsy of childhood with structural changes in the brain and benign epileptiform patterns on EEG (FEDSIM-BEPD). Abstract of a doctor of medicine dissertation. Moscow, 2017. 26 p. (In Russ.).
8. Zelinskaya D.I. On the state of childhood disability and the implementation of the Federal Target Program “Disabled Children”. Rossiyskiy pediatricheskiy zhurnal = Russian Pediatric Journal 2001;(2):4–7. (In Russ.).
9. Clinical guidelines “Epilepsy and epileptic status in adults and children” 2022–2024. Available at: https://www.consultant.ru/ document/cons_doc_LAW_42469. (In Russ.).
10. Kuzmich G.V. Clinical and prognostic significance of epileptiform activity on EEG in children with cerebral palsy in the absence of epilepsy Abstract of a doctor of medicine dissertation. Moscow, 2014. 26 p. (In Russ.).
11. Kuzmich G.V., Sinelnikova A.N., Mukhin K.Yu. Controversial issues of autism and epilepsy comorbidity: subclinical epileptiform activity and autistic epileptiform regression. Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2019;14(1):40–8. (In Russ.). DOI: 10.17650/2073-8803-2019-14-1-40-48
12. Malinovskaya O.N., Belousova E.D., Keshishyan E.S. Risk factors and prognosis of cerebral palsy and epileptic syndromes in premature infants with periventricular leukomalacia. Rossiyskiy vestnik perinatalogii i pediatrii = Russian Bulletin of Perinatology and Pediatrics 2005;(3):30–5. (In Russ.).
13. Mironov M.B., Bobylova M.Yu., Nekrasova I.V. et al. Differential diagnostics of paroxysms of tonic muscle tension of epileptic and non-epileptic nature in young children with delayed psychomotor development and focal neurological symptoms. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = Korsakov Journal of Neurology and Psychiatry 2017;117(6):4–9. (In Russ.). DOI: 10.17116/jnevro2017117614-9
14. Mukhin K.Yu., Glukhova L.Yu., Kholin A.A. Epilepsy. Atlas of electroclinical diagnostics and therapy. Vol. 1, 2. Moscow: Russkiy pechatnyy dvor, 2024. 912 p. (In Russ.).
15. Mukhin K.Yu., Glukhova L.Yu., Bobylova M.Yu. et al. Epileptic syndromes. Diagnostics and therapy. Handbook for physicians. 4th edn. Moscow: Izdatelskiy dom “BINOM”, 2018. Pp. 149–330. (In Russ.).
16. Mukhin K.Yu., Mironov M.B., Borovikov K.S., Petrukhin A.S. Focal epilepsy of childhood with structural changes in the brain and benign epileptiform patterns on EEG (FEDSIM-BEPD) (preliminary results). Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2010;5(1):3–18. (In Russ.).
17. Mukhin K.Yu., Pylaeva O.A. Use of zonisamide (Zonegran) in the treatment of epilepsy in adults and children (review of foreign literature and case description). Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2015;10(1):47–63. (In Russ.). DOI: 10.17650/2073-8803-2015-1-47-63
18. Omelchenko N.N., Levitina E.V. Risk factors for the formation of epileptic syndrome and its influence on the development of higher epileptic functions in children with cerebral palsy. Meditsinskaya nauka i obrazovanie Urala = Medical Science and Education of the Ural 2007;(6):58–60. (In Russ.).
19. Rakhmanina O.A., Levitina E.V., Khramova E.B. et al. Comparative analysis of zonisamide and topiramate use in treatment of pediatric epilepsy in real clinical practice: the results of a retrospective study and related clinical cases. Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2019;14(4):17–25. (In Russ.). DOI: 10.17650/2073-8803-2019-14-4-17-25
20. Semenova K.A. Clinic and rehabilitation therapy of children’s cerebral palsy. Moscow: Meditsina, 1972. 328 p. (In Russ.).
21. Federal Guide to Child Neurology. Ed. by V.I. Guzeva. Moscow: Special Publishing House of Medical Books, 2016. 649 p. (In Russ.)
22. Al-Sulaiman A. Electroencephalographic findings in children with cerebral palsy: A study of 151 patients. Funct Neurol 2001;16:325–8.
23. Cooper M.S., Mackay M.T., Fahey M. et al. Seizures in children with cerebral palsy and white matter injury. Pediatrics 2017;139(3). PII: e20162975. DOI: 10.1542/peds.2016-2975
24. Gidal B.E., Resnick T., Smith M.C., Wheless J.W. Zonisamide: A comprehensive, updated review for the clinician. Neurol Clin Pract 2024;14(1):e200210. DOI: 10.1212/CPJ.0000000000200210
25. Guerrini R., Rosati A., Segieth J. et al. Zonisamide in pediatric patients. Epilepsia 2013;54(8):1473–80.
26. Gürkan F., Gökben S., Serin H.M. et al. Determining risk factors of epilepsy in children with cerebral palsy: A retrospective study. J Pediatr Res 2018;5(2):76–81. DOI: 10.4274/jpr.24471
27. Rajeshkannan B., Ravikumar K. Risk factors for seizures in children with cerebral palsy – a descriptive study. J Dental Med Sci 2017;16(3):9–11. DOI: 10.9790/0853-1603030911
Review
For citations:
Bobylova M.Yu., Borovikov K.S. Use of zonisamide in children with cerebral palsy and epilepsy: literature review and own data. Russian Journal of Child Neurology. 2025;20(2):23-33. (In Russ.) https://doi.org/10.17650/2073-8803-2025-20-2-23-33