Limited efficacy of zonisamide in the treatment of refractory infantile spasms
| Autor: | Rajsekar R. Rajaraman, Shaun A. Hussain, Matthew Ji, Brenda Asilnejad, Raman Sankar, Haley Peters, Mario Navarro, Jaeden Heesch |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pediatrics
medicine.medical_specialty hypsarrhythmia epileptic spasms Zonisamide lcsh:RC346-429 Vigabatrin 03 medical and health sciences 0302 clinical medicine Interquartile range medicine Short Research Article lcsh:Neurology. Diseases of the nervous system 030304 developmental biology 0303 health sciences business.industry West syndrome medicine.disease Hypsarrhythmia 3. Good health Epileptic spasms Neurology Tolerability Cohort Hormonal therapy Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Epilepsia Open Epilepsia Open, Vol 5, Iss 1, Pp 121-126 (2020) |
| ISSN: | 2470-9239 |
| Popis: | A series of relatively small studies collectively suggest that zonisamide may be effective in the treatment of infantile spasms. Using a large single‐center cohort of children with infantile spasms, we set out to evaluate the efficacy and safety of zonisamide. We retrospectively identified all patients with infantile spasms who were treated with zonisamide at our center. For each patient, we recorded dates of birth, infantile spasms onset, response (if any), and most recent follow‐up. To quantify zonisamide exposure, we recorded daily dosage and patient weight at each sequential encounter so as to allow calculation of peak and weighted‐average weight‐based dosage. We identified 87 children who were treated with zonisamide, of whom 78 had previously been treated with hormonal therapy or vigabatrin. Peak and weighted‐average zonisamide dosage were 7.1 (interquartile range 3.6, 10.2) and 5.4 (interquartile range 3.0, 8.9) mg/kg/day, respectively. Whereas five (6%) patients exhibited resolution of epileptic spasms, only two (2%) patients exhibited video‐EEG confirmed resolution of both epileptic spasms and hypsarrhythmia (electroclinical response). Importantly, both electroclinical responders had not previously been treated with hormonal therapy or vigabatrin; in contrast, none of the 78 children with prior failure of hormonal therapy or vigabatrin subsequently responded to zonisamide. Zonisamide was well tolerated, and there were no deaths. This study suggests that zonisamide exhibits favorable tolerability but very limited efficacy among patients who do not respond to first‐line therapy. |
| Databáze: | OpenAIRE |
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