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Felbamate in the treatment of refractory epileptic spasms
Shaun A Hussain1, Brenda Asilnejad1, Jaeden Heesch1
1David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States.
Insights
Felbamate shows potential efficacy in treating infantile epileptic spasms, especially in younger patients. Further research is needed to confirm these findings for this challenging epilepsy syndrome.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Conflicting data exists on felbamate's effectiveness for epileptic spasms.
- Previous treatments like hormonal therapy and vigabatrin often fail.
Purpose of the Study:
- To retrospectively evaluate the efficacy and safety of felbamate in a large cohort of children with epileptic spasms.
- To identify factors influencing felbamate response in this population.
Main Methods:
- Retrospective analysis of 62 children with video-EEG confirmed epileptic spasms treated with felbamate.
- Quantification of felbamate dosage and definition of clinical and electroclinical response.
- Subgroup analysis based on disease duration before treatment initiation.
Main Results:
- Only 8% achieved clinical response and 3% electroclinical response.
- Higher response rates (24%) were observed in patients with disease onset less than 12 months prior to felbamate initiation.
- Most patients (58/62) had prior treatment failures.
Conclusions:
- Felbamate may offer a viable treatment option for some children with epileptic spasms, particularly when initiated earlier.
- Rigorous prospective studies are necessary to validate these preliminary findings and establish optimal usage guidelines.
Abstract:
Several small case series provide conflicting impressions of the efficacy of felbamate for treatment of epileptic spasms. Using a large single-center cohort of children with epileptic spasms, we retrospectively evaluated the efficacy and safety of felbamate. We identified all patients with video-EEG confirmed epileptic spasms who were treated with felbamate at our center. We quantified felbamate exposure by calculating peak and weighted-average weight-based dose. Clinical response was defined as resolution of epileptic spasms for at least 28 days, beginning not more than 3 months after felbamate initiation. Electroclinical response was defined as clinical response accompanied by overnight video-EEG demonstrating freedom from epileptic spasms and hypsarrhythmia. Among a cohort of 476 infants, we identified 62 children who were treated with felbamate, of whom 58 had previously failed treatment with hormonal therapy or vigabatrin. Median peak and weighted-average felbamate dosages were 47 and 40 mg/kg/day, respectively. Five (8%) children were classified as clinical responders and two (3%) children were classified as electroclinical responders. Among 17 patients with latency from epileptic spasms onset to felbamate initiation of less than 12 months, we observed 4 (24%) clinical responders. This study suggests that felbamate may be efficacious for treatment of epileptic spasms and that further rigorous study is warranted.
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