Infantile spasm is an age-related refractory epilepsy. Topiramate is a new anticonvulsant with multiple mechanisms of action, and it may be effective for treating pediatric epilepsies. To evaluate the efficacy and tolerability of first-line topiramate treatment for infantile spasm, 20 patients received topiramate monotherapy during this study. They were treated with an initial dose of 1 mg/kg/day, with a progressive titration of 1 mg/kg a week until their spasms were controlled and a maximum dose of 12 mg/kg/day was achieved. The evaluation of the treatment efficacy was based on the spasm frequency data that was obtained by the scalp and video-EEG, and by the parental count of spasm. Thirty percent of the subjects became spasm-free during the study. Six of 20 subjects (30%) had cessation of spasm and disappearance of hypsarrhythmia as seen via the video EEG; four (50%) of eight idiopathic patients had a response, whereas two (17%) of 12 patients with symptomatic infantile spasm responded. Seventy of the patients, including the spasm-free patients, had a reduction in their seizure frequency of more than 50%, and 10% of the patients had a reduction in their seizure frequency of less than 50%. The clusters of spasm frequency decreased from 10.6 ± 8.5 to 3.5 ± 1.4 clusters/day. Topiramate is effective and tolerated in those patients suffering from infantile spasm. Our results suggest that this drug should be considered as a new first-line drug for treating infantile spasm.
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机译:小儿痉挛是一种与年龄有关的难治性癫痫。托吡酯是一种具有多种作用机制的新型抗惊厥药,对治疗小儿癫痫病可能有效。为了评估托吡酯一线治疗婴儿痉挛的疗效和耐受性,本研究中有20名患者接受了托吡酯单药治疗。他们以1 mg / kg /天的初始剂量进行治疗,每周逐步递增1 mg / kg的剂量,直到他们的痉挛得到控制,并达到最大剂量12 mg / kg /天。治疗效果的评估基于通过头皮和视频EEG获得的痉挛频率数据以及父母的痉挛计数。在研究过程中,有30%的受试者免于痉挛。通过视频脑电图观察,在20名受试者中有6名(30%)停止了痉挛,并出现了心律失常。 8例特发性患者中有4例(50%)有反应,而12例有症状的婴儿痉挛症患者中有2例(17%)有反应。包括无痉挛患者在内的70名患者的癫痫发作频率降低了50%以上,其中10%的患者癫痫发作频率降低了50%以下。痉挛频率的群集从每天的10.6±8.5降低到3.5±1.4群集/天。托吡酯在患有婴儿痉挛症的患者中有效且可耐受。我们的结果表明,该药物应被视为治疗婴儿痉挛症的一线新药。
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