Efficacy of Thyrotropin-Releasing Hormone in the Treatment of Intractable Epilepsy

Autor: Hiroko Matsushita, Yoshihiro Takeuchi, Ichiro Yamazoe, Kazushi Takaya, Tadashi Sawada, Hisakazu Uehara, Yuri Miyanomae
Rok vydání: 1998
Předmět:
Zdroj: Epilepsia. 39:82-82
ISSN: 1528-1167
0013-9580
DOI: 10.1111/j.1528-1157.1998.tb01978.x
Popis: Purpose: Despite rapid advances in the treatment of epilepsy with the introduction of new drugs, the seizures in a number of children with epilepsy remain uncontrollable. Thus a more potent, yet safer therapy is needed. Adrenocorticotropic hormone (ACTH) has been used to treat children with intractable epilepsy, such as West syndrome and Lennox-Gastaut syndrome. However, ACTH administration is occasionally associated with serious side effects, including immunosuppression, hypertension, and brain shrinkage. Consequently, in this study, the efficacy of an endogenous hormone, thyrotropin-releasing hormone (TRH), was reevaluated for the treatment of intractable epilepsy. Methods: From 1991 to 1996, we studied the efficacy of TRH-tartrate (TRH-T) in 34 children with intractable epilepsy (16 with West syndrome, 11 with Lennox-Gastaut syndrome, three with localization-related epilepsies, two with severe myoclonic epilepsy, one with early myoclonic encephalopathy, and one with Angelman syndrome). TRH-T was administered intravenously or intramuscularly at a dose of 0.05 mg/kg/day once per day for 4 weeks. The subjects were classified into three groups based on the frequency of their seizures and the EEG effects: cessation of seizures and seizure discharges for >1 year (very effective group), a >50% reduction in the frequency of seizures or seizure discharges or both (effective group), and no changes in the frequency of seizures or seizure discharges (ineffective group). Results: There were eight cases in the very effective group, 10 in the effective group, and 16 in the ineffective group. The patients in the very effective group stopped having seizures, including infantile spasms, tonic seizures, atypical absence, atonic seizures, myoclonic seizures, and partial seizures within 11 days to 3 months after the initiation of the TRH therapy. It is noteworthy that no seizures occurred for >3 years in four of the eight cases in the very effective group. The 16 patients with West syndrome comprised five cases in the very effective group, two in the effective group, and nine in the ineffective group. The 11 patients with Lennox-Gastaut syndrome were subdivided into three cases in the very effective group, three in the effective group, and five in the ineffective group. All three patients with localization-related epilepsies were in the effective group. Conclusions: TRH should be considered as a possible treatment for Lennox-Gastaut syndrome and West syndrome, especially for a patient who has an. infection or severe organic lesions in the brain, or who is immunosuppressed. It is noteworthy that TRH is also effective in the treatment of intractable localization-related epilepsies. The relatively long duration of the action of TRH after the termination of administration may indicate that the mechanism for its anticonvulsant action differs from those of other anticonvulsant drugs.
Databáze: OpenAIRE
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