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Efficacy of gabapentin therapy in children with refractory partial seizures
D S Khurana1, J Riviello, S Helmers
1Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Gabapentin, an adjunctive therapy, showed promise in reducing seizure frequency in children with refractory partial epilepsy. Some children experienced significant seizure reduction, with a few becoming seizure-free.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Refractory partial epilepsy in children presents significant treatment challenges.
- Existing antiepileptic drug regimens are often insufficient for complete seizure control.
Purpose of the Study:
- To evaluate the efficacy and tolerability of gabapentin as adjunctive therapy in pediatric patients with refractory partial epilepsy.
- To assess the impact of gabapentin on seizure frequency and identify potential side effects.
Main Methods:
- An open-label study involving 32 children with refractory partial epilepsy.
- Gabapentin was administered as an add-on therapy at doses ranging from 10 to 50 mg/kg/day.
- Seizure frequency was compared to baseline, and pharmacokinetic parameters were analyzed.
Main Results:
- 34.4% of patients experienced a >50% decrease in seizure frequency; 12.5% had a 25-50% decrease.
- In a subset of 7 children treated for ≥6 months, 2 were seizure-free and 4 were almost seizure-free.
- Behavioral side effects (hyperactivity, irritability) were noted in children with comorbid attention deficit and mental retardation.
Conclusions:
- Gabapentin demonstrates potential as a beneficial adjunctive medication for pediatric refractory partial epilepsy.
- The drug's efficacy in reducing seizure frequency warrants further investigation, particularly in specific patient subgroups.
- Careful monitoring for behavioral side effects is recommended, especially in children with pre-existing attention and cognitive deficits.
Abstract:
Thirty-two children with refractory partial epilepsy received open-label gabapentin as an additional medication to their antiepileptic drug regimen. Gabapentin was given in a dose ranging from 10 to 50 mg/kg per day (mean dose, 26.7 mg/kg daily). All patients had partial seizures with or without secondary generalization. Compared with baseline, 11 patients (34.4%) had a greater than 50% decrease in seizure frequency, and 4 (12.5%) had a 25% to 50% decrease in seizure frequency. Of the seven children who received the medication for 6 months or longer, two were seizure free and four were almost seizure free (having one seizure every few months). Mean gabapentin concentration was 4.8 micrograms/ml, and mean apparent clearance was 372 ml/kg per hour. The major reported side effects were behavioral. These consisted of hyperactivity, irritability, and agitation that occurred in patients with baseline mental retardation with attention deficit. We conclude that gabapentin can be a useful adjunctive medication in the treatment of refractory partial epilepsy in children.