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Treatment of infantile spasms with zonisamide
1Department of Pediatric Neurology, Fukuoka Children's Hospital, Japan. yanais@alles.or.jp
Insights
Zonisamide (ZNS) effectively treated infantile spasms in 33.3% of newly diagnosed children. This study found ZNS well-tolerated and a promising early-stage therapy for infantile spasms, with rapid seizure disappearance in many cases.
Area of Science:
- Neurology
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Infantile spasms (IS) are a severe form of epilepsy in infants.
- Early diagnosis and effective treatment are crucial for improving outcomes in IS.
- Zonisamide (ZNS) is an antiepileptic drug with a known mechanism of action.
Purpose of the Study:
- To evaluate the efficacy and tolerability of zonisamide (ZNS) in children with newly diagnosed infantile spasms.
- To determine optimal dosing and treatment duration for ZNS in this patient population.
- To assess the impact of ZNS on seizure control and hypsarrhythmia on EEG.
Main Methods:
- A prospective study involving 27 children with newly diagnosed infantile spasms.
- ZNS was administered as monotherapy or add-on therapy at doses ranging from 4-20 mg/kg/day.
- Dosage adjustments were made based on seizure response, with a target of seizure disappearance.
Main Results:
- Zonisamide led to seizure disappearance in 33.3% (9/27) of patients.
- Effectiveness was observed in all cryptogenic cases and 28% of symptomatic cases.
- The mean time to seizure cessation was 5.0 days, with no adverse reactions reported.
Conclusions:
- Zonisamide is an effective and well-tolerated treatment option for newly diagnosed infantile spasms.
- ZNS demonstrates potential as an early-stage therapeutic intervention for IS.
- Further research may explore long-term efficacy and safety profiles of ZNS in IS management.
Abstract:
We determined the efficacy of and tolerability to zonisamide (ZNS) in newly diagnosed patients with infantile spasms. ZNS, 4-20 mg/kg per day, was introduced as an add-on therapy or monotherapy in 27 children with infantile spasms (cryptogenic, 2; symptomatic, 25). The dosage was initially 2-4 mg/kg per day, and then was increased by 2-5 mg/kg every 2-4 days until the seizures disappeared. Nine (33.3%) out of the 27 patients who were administered ZNS exhibited the disappearance of seizures. ZNS was effective in all the cryptogenic cases and seven (28.0%) of the symptomatic cases. The effective daily doses were 5-12.5 mg/kg (mean, 7.8 mg/kg), and the daily dosages were 40-100 mg (mean, 61.1 mg). The steady-state plasma ZNS concentrations were almost within the therapeutic range. The mean time interval between the start of ZNS therapy and the seizure disappearance was 5.0 days. Six (75.0%) of eight effective cases, the exception being one for whom EEG was not performed after the therapy, showed the disappearance of hypsarrhythmia. The recurrence of seizures were observed in four of the nine cases. No adverse reaction to ZNS was noted in any patient. In conclusion, ZNS treatment is considered to be worthwhile trying, for early stage therapy for infantile spasms.