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Gazzetta Medica Italiana Archivio per le Scienze Mediche 1998 June;157(3):71-3

Copyright © 1998 EDIZIONI MINERVA MEDICA

language: Italian

Vigabatrin and lamotrigine in intractable secondary epilepsies. Personal experience

Perini M., Lischetti M. R., Buganza V., Sala M.

Istituto Sacra Famiglia, Cesano Boscone - Milano


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Background. Several new anti­epi­lep­tic ­drugs (AED) ­have ­been pro­posed in the ­last ­years to re­duce sei­zures in intract­able epi­lep­sy.
Methods. We stud­ied the ther­a­peu­ti­cal ef­fects, elec­tro­en­ceph­a­lo­gram (EEG) mod­ifi­ca­tions and ­side ef­fects of two AED, vigabatrin and lamotri-­gine, on a co­hort of 9 pa­tients af­fect­ed by ce­re­bral pal­sy, ­with se­vere men­tal de­te­ri­ora­tion and epi­lep­sy (sev­er­al gen­er­al­ized aton­ic or ton­ic sei­zures in a ­week). We be­gan to in­tro­duce Vigabatrin to pre­vi­ous ther­a­py.
Results. After 3 ­months we not­ed in 4 cas­es an in­itial ­good re­sponse to vigabatrin, ­with 50% sei­zures re­duc­tion and EEG im­prove­ment. Behaviour ab­nor­mal­ities ­were re­port­ed in one pa­tient. However, af­ter one ­year treat­ment, in all cas­es we not­ed an in­crease in sei­zures num­ber and EEG ab­nor­mal­ities. Gradually vigaba-­trin was sob­sti­tut­ed by lamotrigine. After 3 ­months ther­a­py we not­ed in 6 cas­es a ­good re­sponse to lamotrigine, ­with 50% sei­zures re­duc­tion and EEG im­prove­ment. Vomiting due to in­crease plas­ma val­proate so­di­um con­cen­tra­tions was re­port­ed in one pa­tient. With lamotrigine, ­this ­good re­sponse was ­still ­present af­ter one ­year treat­ment.
Conclusions. In our co­hort of 9 pa­tients, af­ter in­itial ­good ther­a­peu­ti­cal re­sponse, vigabatrin par­tial­ly ­lost its ef­fects in a ­year ­even if sei­zures fre­quen­cy was ­still re­duced in com­par­i­son ­with the num­ber of at­tacks be­fore ­this ther­a­py. Substitution of vigabatrin ­with lamotrigine was use­ful, in our pa­tients, to ob­tain a bet­ter con­trol of sei­zures num­ber and EEG ab­nor­mal­ities in the ­first ­year. We are mon­i­tor­ing ­these ­data, in or­der to con­trol lamotrigine ef­fi­ca­cy in ­next ­years.

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