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Published on: May 16, 2019
Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy
1Division of Pediatric Neurology, Chang Gung Children's Hospital, and Medical College of Chang Gung University, Taoyuan, Taiwan. wanghs444@cgmh.org.tw
Insights
Pyridoxal phosphate (PLP) shows promise in controlling intractable childhood epilepsy, especially infantile spasms, offering an alternative to pyridoxine (PN). Some children require PLP exclusively for sustained seizure freedom.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Idiopathic intractable epilepsy in children presents a significant therapeutic challenge.
- Pyridoxine (PN) and its active form, pyridoxal phosphate (PLP), are vitamin B6 derivatives involved in neurological function.
- Understanding the differential efficacy of PN and PLP in epilepsy management is crucial.
Purpose of the Study:
- To compare the effectiveness of pyridoxal phosphate (PLP) versus pyridoxine (PN) in managing pediatric idiopathic intractable epilepsy.
- To determine if PLP can serve as a superior alternative to PN in this patient population.
Main Methods:
- A cohort of 94 children diagnosed with idiopathic intractable epilepsy received intravenous PLP.
- Dosage adjustments were made based on seizure recurrence, with transitions to oral PN or continued PLP.
- Treatment responses were monitored, distinguishing between generalized and focal seizures, including infantile spasms.
Main Results:
- Eleven out of 94 patients showed dramatic and sustained responses to PLP.
- Five of these responders achieved seizure freedom with PN or PLP, with three requiring PLP for maintenance.
- Six responders needed exclusive PLP treatment, particularly those with infantile spasms (4 out of 6).
Conclusions:
- Pyridoxal phosphate (PLP) demonstrates potential as a replacement for pyridoxine (PN) in treating intractable childhood epilepsy.
- PLP appears particularly effective for infantile spasms, with some cases requiring exclusive PLP therapy for seizure control.
Aim:
To study the difference between pyridoxine (PN) and its active form, pyridoxal phosphate, (PLP) in control of idiopathic intractable epilepsy in children.
Methods:
Among 574 children with active epilepsy, 94 (aged 8 months to 15 years) were diagnosed with idiopathic intractable epilepsy for more than six months. All received intravenous PLP 10 mg/kg, then 10 mg/kg/day in four divided doses. If seizures recurred within 24 hours, another dose of 40 mg/kg was given, followed by 50 mg/kg/day in four divided doses. For those patients whose seizures were totally controlled, PLP was replaced by the same dose of oral PN. If the seizure recurred, intravenous PLP was infused followed by oral PLP 50 mg/kg/day.
Results:
Fifty seven patients had generalised seizures (of whom 13 had infantile spasms) and 37 had focal seizure. Eleven had dramatic and sustained responses to PLP; of these, five also responded to PN. Within six months of treatment with PLP or PN, five of the 11 patients were seizure free and had their previous antiepileptic medicine tapered off gradually. Two were controlled with pyridoxine and the other three needed PLP to maintain seizure freedom. The remaining six responders needed PLP exclusively for seizure control. Six of the 11 responders to PLP had infantile spasms (46%); four of them needed PLP exclusively. The other five responders were in the remaining 81 patients with other seizure type.
Conclusions:
PLP could replace PN in the treatment of intractable childhood epilepsy, particularly in the treatment of infantile spasms.
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