Cutaneous Adverse Drug Reaction to Anti-Seizure Medications among Children in a Tertiary Hospital in Rivers State, Nigeria: A Prospective Observational Study

Abstract

Background/Aim: Anti-seizure medications (ASMs) are often used as the first line of treatment for seizure control in children with epilepsy. The management of epilepsy can be significantly hampered by an adverse drug reaction, which is a risk factor for poor drug adherence. This prospective observational study aims to determine the pattern of cutaneous adverse drug reaction (cADR) to ASMs among children in the University of Port Harcourt Teaching Hospital. Methods: This was a prospective observational study conducted from 2023 to 2025 among children who developed cutaneous lesions following administration of ASMs for either epilepsy or other reasons in the University of Port Harcourt Teaching Hospital. Results: Anti-seizure medications were commenced in 256 children between 2023 and 2025; 28 (10.9%) reported cutaneous reactions. More males 19(67.9%) had cADRs than females (9; 32.1%). Cutaneous ADRs to ASMs were higher among those who were 10 years and below (70.0%). Most reactions occurred within the first week of commencing ASMs in 18(64.3%) participants. Carbamazepine, an aromatic ASM, accounts for 16 (53.6%) of cADR, followed by phenobarbital (17.9%) in 5 patients. The types of cADRs reported were maculopapular rashes in 19 (67.9%) patients, urticaria in 4 (14.3%), Stevens-Johnson Syndrome in 2 (7.1%) patients, while fixed drug eruption and erythema multiforme occurred in 1 (3.6%) patient, respectively. Three (10.7%) patients were hospitalized following the cADR. No mortality was recorded. Conclusion: Cutaneous adverse reaction to ASMs is not rare in children, with aromatic compounds, particularly carbamazepine, as the most common culprit. The younger age group was more affected, and most of the cADRs occurred within the first week of commencing ASMs. Physicians need to provide appropriate counselling to patients and their caregivers on the possible adverse drug reactions when prescribing ASMs. Also, routine follow-up visits should be scheduled for all patients commenced on a new ASMs, which allows for timely diagnosis and treatment of any resulting cutaneous adverse drug reactions.