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Vigabatrin: rational treatment for chronic epilepsy
H A Ring1, A J Heller, I N Farr
1Department of Neurology, Maudsley Hospital, London, United Kingdom.
Journal of Neurology, Neurosurgery, and Psychiatry
|December 1, 1990
Summary
Vigabatrin, an inhibitor of GABA transaminase, significantly reduced seizure frequency in adults with refractory epilepsy. Patients on vigabatrin maintained seizure reduction, unlike those on placebo, indicating its potential as an epilepsy treatment.
Area of Science:
- Neuroscience
- Pharmacology
Background:
- Epilepsy is a chronic neurological disorder characterized by recurrent seizures.
- Refractory epilepsy often requires adjunctive therapies when standard treatments are insufficient.
- Gamma-aminobutyric acid (GABA) is a key inhibitory neurotransmitter in the brain.
Purpose of the Study:
- To evaluate the efficacy and safety of vigabatrin as an add-on therapy for adult patients with refractory epilepsy.
- To assess the impact of vigabatrin on seizure frequency in a double-blind, placebo-controlled setting.
Main Methods:
- An open-label phase involving 33 adult patients with refractory epilepsy, adding vigabatrin (up to 3g daily) for eight weeks.
- A subsequent eight-week double-blind, placebo-controlled phase with 20 patients who showed at least a 50% seizure reduction in the open phase.
- Monitoring of seizure frequency and adverse events throughout the study.
Main Results:
- Vigabatrin addition resulted in a 48.2% reduction in seizure frequency during the open-label phase.
- Patients on vigabatrin maintained a 54.7% seizure reduction in the double-blind phase, while the placebo group experienced an 18.6% increase (p < 0.001).
- Common adverse events included drowsiness, depression, mood instability, and headaches; most were reversible.
Conclusions:
- Vigabatrin is a potentially valuable new treatment for chronic epilepsy, particularly partial seizures.
- The drug's mechanism involves irreversible inhibition of GABA transaminase, increasing GABA levels.
- Careful monitoring for adverse events is recommended during vigabatrin therapy.