Effects of Combination Antiepileptic Drug Therapy on Seizure Frequency, Laboratory Parameters, and Quality of Life in Children with Drug-Resistant Epilepsy: Prospective Observational Cohort Study

Objective: Drug-resistant epilepsy (DRE) presents a persistent therapeutic challenge in pediatric neurology, often affecting seizure control, systemic health, and quality of life. This study aimed to evaluate seizure frequency, laboratory parameters, and quality of life outcomes in children with DRE receiving different combinations of antiepileptic drugs (AEDs). Material and Methods: A prospective observational cohort study was conducted from June to December 2024 involving 65 pediatric patients with DRE from 2 hospitals in Indonesia. Participants were classified based on AED regimens: Group 1 (oldergeneration AEDs) and Group 2 (newer-generation AEDs). Baseline and followup data were collected over 3 months, including hematological and biochemical markers, seizure frequency, and Pediatric Quality of Life InventoryTM scores. Results: Both groups showed significant reductions in seizure frequency (p=0.001). Hematological parameters, including hemoglobin and hematocrit, changed significantly during follow-up in both groups (p=0.001). Group 2 exhibited a significant reduction in liver enzyme levels (ALT: p=0.001; AST: p=0.002), indicating no evidence of progressive hepatic deterioration during follow-up, while Group 1 showed modest changes in renal parameters without evidence of deterioration, reflected by decreased serum creatinine levels (p=0.007). Cognitive function, as measured by the Mini-Mental State Examination, improved in both groups. However, quality of life scores declined significantly in Group 1 across all age groups, whereas Group 2 showed stable or less pronounced declines. Conclusion: AED polytherapy was associated with improved seizure control, cognitive function, and laboratory outcomes. However, quality of life responses varied, highlighting the need for individualized treatment strategies in pediatric DRE.