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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.54 no.1 São Paulo Mar. 1996 

High doses of carbamazepine for refractory partial epilepsy


Altas doses de carbamazepina para epilepsia parcial refratária



Cristiana Borges Pereira; Carlos Otto Heise; Arthur Cukiert

Department of Neurology and Neurosurgery of the University of São Paulo School of Medicine




Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carbamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day (1200 mg/day, n=18; 1300mg/day, n=1; 1400 mg/day, n=7; 1600 mg/day, n=9; 1700 mg/day, n=4; 1800 mg/day, n=8; 1900 mg/day, n=1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M=25.6). Seizure's control was observed in 7 (14.48%) patients taking 1200 mg/day and in 2 (4.16%) patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21%). Ten patients (20.81%) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to significant side effects.

Key-words: epilepsy, carbamazepine, effectiveness, side effects.


Foram analisados 48 pacientes epilépticos com crises parciais que faziam uso de carbamazepina (CBZ) em doses iguais ou superiores a 1200 mg por dia. Trinta e três estavam em monoterapia e 15 em politerapia. As outras medicações foram mantidas constantes durante a manipulação da dose de CBZ nos pacientes em politerapia. O critério utilizado para o aumento da dose de CBZ foi a falta de controle clínico e a ausência de efeitos colaterais (independente da dosagem sérica). A dose máxima variou de 1200 a 1900 mg/dia (1200 mg, n=18; 1300 mg/dia, n=1; 1400 mg/dia, n=7; 1600 mg/dia, n=9; 1700 mg/dia, n=4; 1800 mg/dia, n=8 ; 1900 mg/dia, n=1). Dosagens séricas de anticonvulsivantes eram utilizadas no sentido de confirmar a aderência ao tratamento. A média das dosagens disponíveis foi de 9,6 ug/mL. O tempo de seguimento variou de 3 a 96 meses (M=25,6). Houve controle das crises em 7 (14,48 %) pacientes com 1200 mg/dia e em 2 (4, 16 %) pacientes com 1400 mg/dia. Trinta e nove pacientes nao obtiveram controle (81,21%). Dez pacientes (20,81 %) mostraram sinais de intoxicação. Quando doses de CBZ até 1400 mg não são eficazes, doses mais altas da droga são frequentemente incapazes de controlar as crises epilépticas. Nesta situação, a chance de intoxicação aumenta significativamente sem que haja beneficios para o paciente.

Palavras-chaves: epilepsia, carbamazepina, efeitos colaterais, eficacia.



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Aceite: 9-outubro-1995.



Dr. Arthur Cukiert - Rua Nova York 744 apto 131 - 04560-001 São Paulo SP - Brasil.

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