The spectrum and efficacy of antiepileptic drugs in patients with infantile spasms in Russia


https://doi.org/10.17749/2077-8333.2018.10.2.051-058

Full Text:


Abstract

Recently, the International League Against Epilepsy (ILAE) defined epileptic spasms as a separate type of seizures. According to the international recommendations, the treatment of infantile  spasms (IS) begins with hormones or vigabatrin (in the cases of tuberous sclerosis complex –  TSC). However, in the Russian Federation, other antiepileptic drugs (AEDs) are often used as the first line medications.

Aim: to analyze the current practice of prescribing AEDs for the treatment of epileptic spasms.

Materials and Methods. We studied the medical records of 175 patients with IS (59 of them with TSC) hospitalized for the treatment with hormonal therapy.

Results. Valproic acid was the most commonly prescribed antiepileptic drug in patients with IS  (more than in 80% of cases), both in children with TCS (49/59) and without TCS (102/116). As  expected, the clinical effect (cessation of IS and suppression of hypsarrhythmia) of valproic acid  was insufficient: it was observed in 9/49 (18.4%) children with TSC and in 12/102 (11.2%)  children without TSC. Although ethosuximide, oxcarbazepine, and carbamazepine were known to  be ineffective in IS, they were prescribed by medical doctors and taken by IS patients with no  clinical improvement at all. Taking into account the possible limitation of this analysis (not all of the children were consulted and hospitalized in our clinics), the real efficacy of AEDs might be some higher.

Conclusion. We then conclude that the treatment of IS in the Russian Federation is not in line with the international recommendations and the worldwide clinical practice. There is an urgent need in  updating the national standards for the diagnosis and treatment of IS. The work in this direction is now under way in the Russian Federation.


About the Authors

T. G. Okhapkina
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation

1 Ostrovityanova Str., Moscow 117997, Russia

Junior Researcher, Department of Psychoneurology and Epileptology, N. I. Pirogov Russian National Research Medical University



I. V. Shuljakova
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation

1 Ostrovityanova Str., Moscow 117997, Russia

MD, PhD, Neurologist, Department of Psychoneurology № 2, N. I. Pirogov Russian National Research Medical University



E. S. Ilina
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia Russian Children Clinical Hospital, Ministry of Health of Russia
Russian Federation

1 Ostrovityanova Str., Moscow 117997, Russia

MD, PhD, Head of the Department of Psychoneurology № 2, Children Clinical Hospital of the Ministry of Healthcare of the Russian Federation



G. V. Kalmykova
Belgorod State National Research University “Medical Institute of National University “BelSU”
Russian Federation

85 Pobedy Str., Belgorod 308015, Russia

MD, PhD, Associate Professor, Department of Nervous Diseases and Restorative Medicine, Belgorod State National Research University



M. V. Prytkina
Belgorod State National Research University “Medical Institute of National University “BelSU”
Russian Federation

85 Pobedy Str., Belgorod 308015, Russia

MD, PhD, Head of the Department of Neonatology and Early Age Pathology, Yu. E. Veltischev Research Center for Pediatrics, N. I. Pirogov Russian National Research Medical University



E. D. Belousova
N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation

1 Ostrovityanova Str., Moscow 117997, Russia

MD, PhD (Med. Sciences), Professor, Head of the Department of Psychoneurology and Epileptology, N. I. Pirogov Russian National Research Medical University



References

1. International League Against Epylepsy. URL: https://www.epilepsydiagnosis.org/seizure/epileptic-spasms-overview.html. Accessed: 20.03.18.

2. Avakyan G. N., Blinov D. V., Lebedeva A. V., Burd S. G., Avakian G. G. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2017; 9 (1): 6- 25. DOI: 10.17749/2077-8333.2017.9.1.006-025.

3. Auvin S., Cilio M. R., Vezzani A. Current understanding and neurobiology of epileptic encephalopathies. Neurobiol Dis. 2016 Aug; 92 (Pt A): 72-89. DOI: 10.1016/j.nbd.2016.03.007.

4. International League Against Epylepsy. URL: https://www.epilepsydiagnosis.org/syndrome/west-syndrome-overview.html. Accessed: 20.03.18г

5. Taghdiri M. M., Nemati H. Infantile spasm: a review article. Iran J Child Neurol. 2014 Summer; 8 (3): 1-5.

6. Dimassi S., Labalme A., Ville D. et al. Whole-exome sequencing improves the diagnosis yield in sporadic infantile spasm syndrome. Clin Genet. 2016; Feb; 89 (2): 198-204. DOI: 10.1111/cge.12636.

7. Lemke J. R., Hendrickx R., Geider K., et al. GRIN2B mutations in West syndrome and intellectual disability with focal epilepsy.2014; 75 (1): 147-54. DOI: 10.1002/ana.24073.

8. Child neurology foundation. URL: http://www.childneurologyfoundation.org/disorders/infantile-spasms. Accessed: 20.03.18.

9. Belousova E. D., Shulyakova I. V., Okhapkina T. G. Hormonal treatment in West syndrome. Zh Nevrol Psikhiatr Im S S Korsakova. 2016; 116 (9-2): 61-66.

10. Hassanzadeh R. A., Aminzadeh V. Spasms Treated with Intravenous Methypredinsolone Pulse. Iran J Child Neurol. 2017; 11 (2): 8-12.

11. Lotze T. E., Wilfong A. A. Zonisamide treatment for symptomatic infantile spasms. Neurology. 2004; 27; 62 (2): 296-8.

12. Mitchell W. G., Shah N. S. Vigabatrin for infantile spasms. Pediatr Neurol. 2002; 27 (3): 161-4.

13. Ohtsuka Y. Efficacy and safety of vigabatrin in Japanese patients with infantile spasms: Primary short-term study and extension study. Epilepsy Behav. 2018; 78: 134- 141. DOI: 10.1016/j.yebeh.2017.09.010.

14. Overwater I. E., Bindels-de Heus K., Rietman A. B. et al. Epilepsy in children with tuberous sclerosis complex: Chance of remission and response to antiepileptic drugs. Epilepsia. 2015 Aug; 56 (8): 1239-45. DOI: 10.1111/epi.13050.

15. Song J. M., Hahn J., Kim S. H., Chang M. J. Efficacy of Treatments for Infantile Spasms: A Systematic Review. Clin Neuropharmacol. 2017; 40 (2): 63-84. DOI: 10.1097/WNF.0000000000000200.

16. Moavero R., Marciano S., Graziola F., Curatolo P. Combined targeted treatment in arly onset epilepsy associated with tuberous sclerosis. Epilepsy Behav Case Rep. 2016; (13-5): 13-6. DOI: 10.1016/j.ebcr.2015.12.001.

17. Knupp K. G. Hormonal therapy with vigabatrin is superior to hormonal therapy alone in infantile spasms. J Pediatr. 2017; 184: 235-238. DOI: 10.1016/j.jpeds.2017.02.051.

18. Curatolo P., Verdecchia M., Bombardieri R. Vigabatrin for tuberous sclerosis complex. Brain Dev. 2001 Nov; 23 (7): 649-53. PMID: 11701271.

19. Belousova E. D., Dorofeeva M. Y., Ohapkina T. G. Treatment of epilepsy in tuberous sclerosis. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2016; 8 (2): 37-42. DOI:10.17749/2077-8333.2016.8.2.037-042.


Supplementary files

For citation: Okhapkina T.G., Shuljakova I.V., Ilina E.S., Kalmykova G.V., Prytkina M.V., Belousova E.D. The spectrum and efficacy of antiepileptic drugs in patients with infantile spasms in Russia. Epilepsia and paroxyzmal conditions. 2018;10(2):51-58. https://doi.org/10.17749/2077-8333.2018.10.2.051-058

Views: 107

Refbacks

  • There are currently no refbacks.


ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)