Vigabatrin as first add-on treatment in carbamazepine-resistant epilepsy patients

Numerous clinical reports and several controlled clinical trials have confirmed that vigabatrin is both effective and well-tolerated as an add-on treatment for patients with drug-resistant epilepsy. This report presents the results of a study of 40 patients (22 women and 18 men), aged 19-60 years (mean 37 years), with partial seizures (with or without secondary generalization) and receiving carbamazepine, 600-1800 mg/day. Vigabatrin was given as first add-on drug at a dose of 2-3 g/day for an average of 6 months, in order to assess the clinical response before considering other anti-epilepsy drugs. There was a significant decrease in seizure frequency, from a median of 13 seizures/month at baseline, to 3 seizures/month during the last month on vigabatrin (p < 0.01). Seven patients became seizure-free (17.5%). The most common adverse events experienced during the study were drowsiness, diplopia/blurred vision, and were already present before vigabatrin treatment. In conclusion, vigabatrin is effective as a first add-on therapy for partial epilepsy, refractory to carbamazepine monotherapy, and appears to be a worthy clinical alternative to other drug combinations.