Optimizing the Indication of Vigabatrin in Children With Refractory Epilepsy

Abstract

This review was conducted to evaluate the long-term prognosis of children responding to vigabatrin by examining the incidence of increased seizure frequency, loss of efficacy, and appearance of new seizures in a cohort of 196 children (mean age, 68.2 months; range, 2 months to 19 years) with drug-resistant epilepsy, who had received vigabatrin as add-on treatment in clinical trials. The results indicate that an increase in seizure frequency was uncommon, occurring in only 10% of children with highly drug-resistant epilepsy and that it usually appears shortly after the initiation of treatment. It was clearly not dose-dependent and most often occurred in patients with nonprogressive myoclonic epilepsy. No specific seizure type was specially involved and usually the problem reversed on discontinuing vigabatrin. Loss of efficacy was also uncommon (12% of patients), and again no specific seizure type was found to be associated. Epilepsy syndrome does seem to be a better predictor of loss of efficacy because it occurred most often in symptomatic generalized epilepsies and cryptogenic infantile spasms. A total of 21 patients (11%) developed genuinely new types of seizures. Fifteen of these patients developed new partial seizures that had little impact on the patients' overall clinical improvement. The new partial seizures were better tolerated than the initial seizure type which in most cases had disappeared. Approximately 3% of patients experienced new generalized seizures that aggravated their initial condition. These occurred most often in patients with nonprogressive myoclonic epilepsy; therefore vigabatrin should be used with particular caution in such patients.

Epileptic syndromes, cognitive assessment and school placement: a study of 251 children

“…This finding has major clinical relevance regarding drug-treatment strategy. Indeed, preventing secondary generalisation may be the only possibility, for instance in a sizeable proportion of patients with tuberous sclerosis who, following the treatment of infantile spasms, are left with focal epilepsy (Chiron et al 1991, Lortie et al 1997). The outcome in these patients may be considerably improved by this change in epilepsy syndrome as a result of therapy, although seizures are not brought under total control (Jambaqué et al 2000).…”

Development of Acute Encephalopathy Due to Vigabatrin Use in A Case of Nonketotic Hyperglycinemia

“…Bu istenmeyen etkilerin sıklığı genellikle tedavinin başlangıcında daha fazladır ve sonraları azalır. [12][13][14][15][16][17] Diğer antiepileptik ilaçlarda olduğu gibi, vigabatrin bazı hastalarda vigabatrin ile status epilepticus'u da içeren nöbet sıklığında artışa veya yeni nöbet şekillerinin ortaya çıkmasına neden olabilir. Nadir vakalarda yeni başlayan miyoklonus ya da miyoklonusun alevlenmeleri görülebilir.…”

Stiripentol – characteristic of a new antiepileptic drug

“…As a matter of fact, among the newer AEDs only topiramate has some therapeutic potential for the therapy of SMEI [49] , the other newer AEDs being completely ineffective and lamotrigine has been even documented to exert a proconvulsive effect in SMEI [50][51][52] .…”