No abstract available.
Epilepsy* ; Vigabatrin*

No abstract available.
Epilepsy* ; Vigabatrin*

PURPOSE: To evaluate the efficacy of vigabatrin and valproic acid add-on therapy in the treatment of uncontrolled partial-onset seizures through randomized active controlled parallel-group trial. METHODS: Criteria for entry included a requirement for three or more partial seizures per month despite the blood level of carbamazepine was within therapeutic range. During the 56-day baseline period, patients had at least 6 partial onset seizures. Vigabatrin or valproic acid were administered as the second drug in a randomized fashion. RESULTS: Forty one patients completed the trial(21 for vigabatrin, 20 for valproic acid). There is no statistically significant difference in age, age at onset, baseline seizure frequency, dose of carbamazepine, and serum level of carbamazepine between two groups. Two patients of vigabatrin-treated group and three patients of valproic acid treated group were dropped out because of side effects. The mean vigabatrin and valproic acid does were 2809 and 1490 mg, respectively. The percentage of patients achieving at least a 50% reduction in seizure frequency at the end of 8-week of add-on trial was 62% among vigabatrin-treated patients and was 50% for patients who received valproic acid(not statistically different). There was no significant difference in seizure reduction, percent seizure reduction, and truncated percent seizure reduction between two groups. The side effects were mild and transient neurotoxic symptoms in the patients who completed the trial(5 patients for vigabatrin, 10 patients for valproic acid). CONCLUSIONS: This trial indicates that vigabatrin and valproic acid are safe and effective in the treatment of intractable partial-onset seizures. The efficacy of vigabatrin as a new add-on antiepileptic drug is comparable to the previous valproic acid carbamazepine combination in the sense of seizure reduction and maybe even superior to that in the consideration of side effects
Carbamazepine* ; Humans ; Seizures* ; Valproic Acid* ; Vigabatrin*

PURPOSE: Recently, several reports have documented persistent visual field changes associated with long-term use of Vigabatrin, an antiepileptic drug. Epilepsy is a common disease in children, therefore we investigated perimetric changes in children who were on Vigabatrin treatment. METHODS: Total 36 eyes of 18 patients who had been treated with Vigabatrin were tested with Humphrey Field Analyzer. The visual fields were assessed using central 30-2 threshold test and peripheral 60-4 threshold test. RESULTS: In central 30-2 threshold tests, 13 eyes(40.6%) showed mild visual field constrictions and 4 eyes(12.5%) showed severe visual field constrictions. In peripheral 60-4 threshold tests, 23 eyes(71.8%) showed visual field changes. CONCLUSIONS: Asymptomatic visual field loss may develop in Vigabatrin-treated children. Regular examinations of the visual field is warranted for Vigabatrin-teated children.
Child* ; Constriction ; Epilepsy ; Humans ; Vigabatrin* ; Visual Fields*

Vigabatrin-induced myoclonus is rarely described in adult with partial epilepsy, We report vigavatrin-induced mulrifocal action myoclonus in a 34 year-old female with symptomatic partial epilepsy. Hwe seizures were resistant to catbamazepine. Vigabatrin was started as add-on therapy and multifocal action myoclonus was developed one month later. Myoclonus disappeared after withdrawal of vigabatrin and reappeared with re-use of it. Based on clinical features of myoclonus, her myoclonus may be non-epileptic in nature.
Adult ; Epilepsies, Partial* ; Female ; Humans ; Myoclonus* ; Seizures ; Vigabatrin

PURPOSE: To investigate perimetric changes in pediatric and adolescent patients treated with vigabatrin and to assess the relationship between the visual field defect and the cumulative dose, the duration of treatment, or the age when vigabatrin was first taken. METHODS: Pediatric and adolescent patients treated with vigabatrin for seizure for at least 6 months were examined with Goldmann perimetry. The cumulative dose, the duration of treatment, the age when vigabatrin was first taken, and whether a combination of anticonvulsants and vigabatrin was taken were recorded. Mean radial degree (MRD) determination from the right eye was used to compare the amount of constriction. RESULTS: Visual field constriction developed in 19 (27.1%) out of 70 patients and MRD decreased by 22.7% a mean duration of 86.7+/-27.4 months of treatment. The visual field significantly decreased in the superior, nasal, and inferior field with temporal and central sparing (p<0.001). There was a statistically significant correlation between the average MRD and the cumulative dose (r2=0.1772, p<0.001), and the duration of treatment (r2=0.1713, p<0.001), but no correlation between the average MRD and either the age when vigabatrin was first taken, or the combination of anticonvulsants with vigabatrin. CONCLUSIONS: Visual field constriction developed in one quarter of pediatric and adolescent patients treated with vigabatrin, which significantly correlated with the cumulative dose and the duration of treatment. Therefore, a regular examination of the visual field is warranted for pediatric and adolescent patients treated with vigabatrin.
Adolescent* ; Anticonvulsants ; Constriction ; Humans ; Seizures ; Vigabatrin* ; Visual Field Tests ; Visual Fields*

Many children with epilepsy remain medically intractable inspire of the best available therapies. One of the most difficult seizure types to treat is infantile spasms. Many children will respond to treatment with ACTH but there are may serious side effects and many children relapse when the medication is reduced or discontinued. Thus, new therapies are critically needed for this group of patients. Early evidence from European trials indicated that vigabatrin (Sabril) was effective in this population. A randomized, single blind, high-dose vs low dose vigabatrin study was performed in a multicenter USA trial. Between January 1996 and May 1997, 89 patients from 7 pediatric epilepsy centers were started in the study. An interim evaluation was performed on September 14, 1997. Of the 89 patients, data was not yet available for 16 so 73 patients were evaluable for safety. Efficacy was evaluated in 63 of the patients. Two were eliminated because they had violated the entry criteria and 8 did not yet report the efficacy information and had to be excluded from the interim report.
Adrenocorticotropic Hormone ; Child* ; Epilepsy* ; Humans ; Infant ; Infant, Newborn ; Recurrence ; Seizures ; Spasms, Infantile ; Vigabatrin*

After the first description of infantile spasms (IS) in 1841, extensive clinical and laboratory investigations have been done to find the pathophysiology and the optimal treatments. The concept of the “infantile spasms” has been evolved to the “epileptic spasms”, which includes the spasms outside the infancy the pathophysiology of IS, however, is still unknown. There have been a few randomized trials that proved the efficacy of the anecdotally used drugs in IS including hormonal therapy and vigabatrin. Due to its relative low incidence (1/2000) and the variable etiologies, clinical studies have difficulties in making a clear conclusion. Thus, animal models were eagerly sought to find the pathophysiology based treatments with definite efficacy and several models are now available. In this paper, the current understandings of the epileptic spasms as well as the translational researches using the animal models of IS are reviewed. The latest evidences of therapeutics in IS are discussed shortly.
Incidence ; Infant ; Infant, Newborn ; Models, Animal ; Spasm* ; Spasms, Infantile ; Translational Medical Research ; Vigabatrin

We report a case of atypical benign partial childhood epilepsy in a 11 years old male child whose case has been followed up for 6 years. His first symptom was focal seizure of the left side of his face during a drowsy state, followed by focal seizures of left fingers and legs. At that time he had been on phenobarbital for a year without any response clinically and electroencephalographically, so he was transferred to our hospital. The EEG, which was taken at his first visit, showed continuous generalized spike-wave pattern with high amplitude through the whole record during waking, drowsy and sleeping states. The clinical and EEG findings showed no improvement for the first 2 years even though he was on combination therapy with some drugs such as carbamazepine, valproate and vigabatrin. However, he began to show some improvement after 3 years(at 8 years of age) and no seizure has been observed for the last 2 years. Also an EEG, taken 6 years after onset, showed marked improvement.
Carbamazepine ; Child ; Electroencephalography ; Epilepsy* ; Fingers ; Humans ; Leg ; Male ; Phenobarbital ; Seizures ; Valproic Acid ; Vigabatrin

Vigabatrin (gamma vinyl GABA) was used in an open study of add-on therapy in adult patients with refractory epilepsy. Sixteen chronic epileptic patients (9 males and 7 females) with eight complex partial seizure, seven generalized tonic-clonic seizure and one rnixed seizure were selected from the Neurology department in St. Mary's Hospital of CUMC. Mean duration of epilepsy was 14. 1years, and mean frequency of epileptic attack was 5.2 times a month. Before the entry for the study, all the patients had optimal serum drug levels and were taking one antiepileptic drug to limit of their tolerance. Maintenance doses of vigabatrin ranged from 2 to 3 gram/day. Seizure counts and safety data were assessed at intervals during 6 months follow-up period. Three patients complained of dizziness and G-I trouble and one patient gained weight. No changes in routine laboratory tests and EEG were observed during drug administration. Following administration of 2-3 gram/day vigabatrin, a 75-100% reduction in seizure frequency was observed in 31.3% of patients, and a 50-74% decrease in a further 18.8%. In 37.5% of the patients, the seizure frequency was not changed and more aggravated in one patient. Vigabatrin thus appears to be a well tolerated drug with antiepileptic efficacy in drug resistant cases.
Adult ; Dizziness ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Humans ; Male ; Neurology ; Seizures ; Vigabatrin*