Efficacy of gabapentin therapy in children with refractory partial seizures,☆☆,

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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 μg/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. (J PEDIATR 1996;128:829-33)

Section snippets

Study design

We reviewed the records of all children (1 to 18 years) with intractable partial seizures treated at The Children's Hospital, Boston, Massachusetts, from January 1994 through September 1994. Institutional review board approval was obtained. Patients included in this study fulfilled the specific inclusion criteria as follows: (1) pediatric age group (ages 1 to 18 years), (2) intractable partial seizures that persisted despite appropriate trials of at least three of the first-line AEDs used as

Patient profile

The study population consisted of 32 patients (17 male patients and 15 female patients) with a mean age of 7.1 years (range 2 to 16 years). Eleven (34.4%) were older than 10 years of age and 21 (65.6%) were younger than 10 years. All 21 patients who were younger than 10 years were mentally retarded, and 5 of the 11 patients older than 10 also were retarded. Seventeen patients (53.1%) had moderate to severe mental retardation, nine (28.1%) had mild retardation, and six (18.8%) had normal

DISCUSSION

Our experience indicates that gabapentin can be an effective adjunctive AED in children with refractory partial seizures. About a third of the patients had a greater than 50% reduction in seizure frequency, and two patients became seizure free. These results are similar to the data reported in the various clinical trials of gabapentin therapy in adults.4, 5, 6, 7, 8, 9, 10, 11, 12 In the five randomized, double-blind, placebo-controlled clinical trials in adults, the responder rate (percentage

Acknowledgements

We thank Lorraine Sardano for her assistance in preparing the manuscript.

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    From the Epilepsy Program, Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, and the Department of Pediatrics, American University of Beirut, Lebanon

    ☆☆

    Reprint requests: Mohamad Mikati, MD, Department of Pediatrics, American University Hospital, c/o American University of Beirut New York Office, 850 Third Ave., 18th Floor, New York, NY 10022.

    0022-3476/96/$5.00 +0 9/20/73088

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