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Felbamate for infantile spasms syndrome resistant to first-line treatments
Blandine Dozières-Puyravel1, Hala Nasser2, Vanina Bellavoine1
1Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France.
Insights
Felbamate effectively controlled epileptic spasms in infants with West syndrome resistant to other treatments. Eight infants achieved spasm freedom, with no severe side effects reported, suggesting felbamate as a viable option.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Infantile spasms, also known as West syndrome, are a severe epilepsy disorder in infants.
- Refractory cases often require exploring alternative therapeutic options beyond first-line treatments.
Purpose of the Study:
- To evaluate the efficacy and safety of felbamate in infants with refractory infantile spasms (West syndrome).
- To determine the optimal use of felbamate in this challenging pediatric epilepsy population.
Main Methods:
- A 10-year retrospective study involving 29 infants with electroencephalography-recorded epileptic spasms.
- Infants received felbamate after failure of vigabatrin, oral steroids, and in most cases, a ketogenic diet.
Main Results:
- Eight out of 29 infants (27.6%) became spasm-free with felbamate treatment.
- Mean felbamate dose was 34.6 mg/kg/day. No severe adverse events were noted; reversible neutropenia occurred in six patients.
- One patient experienced relapse upon felbamate discontinuation.
Conclusions:
- Felbamate demonstrates significant efficacy in controlling epileptic spasms in infants with West syndrome refractory to standard therapies.
- Targeting N-methyl-d-aspartate receptors with felbamate may be a beneficial strategy for treatment-resistant cases.
Aim:
To analyse the effects of felbamate in refractory infantile spasms/West syndrome.
Method:
We conducted a 10-year retrospective study of infants (including all infants younger than 18mo) treated with felbamate for electroencephalography-recorded epileptic spasms persisting after first-line treatment.
Results:
In total, 29 infants (17 males, 12 females) were included in the study. Felbamate was initiated at a mean age of 13.8 months (range 4.5-66mo) after sequential administration or combination of vigabatrin and oral steroids; a ketogenic diet was implemented in 23 infants. Eight infants became spasm-free at a mean dose of 34.6mg/kg/day felbamate (range 26-45mg/kg/day). Mean duration of felbamate use was 19 months (range 1-67mo) for the 19 infants whose treatment was terminated. No severe side effects were observed. Reversible neutropenia led to withdrawal of felbamate in six patients. One spasm-free patient demonstrated recurrence when felbamate was withdrawn.
Interpretation:
N-methyl-d-aspartate receptors with felbamate controlled epileptic spasms in eight infants resistant to first-line treatment should be targeted.
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