En niños con epilepsias rebeldes, ¿vigabatrina o lamotrigina?

Abstract

Both vigabatrin (VGB) and lamotrigine (LTG) have been shown to be effective in the control of epileptic crises in double-blind randomized studies, as compared with placebos and as treatment in addition to the classical drugs. In this study we made a retrospective analysis of the evolution of 97 children aged from 6 months to 16 years with resistant epilepsy, to whose treatment either VGB or LTG were added. Frequency of the crises was reduced by > 50% in 54.7% of the children treated with VGB and in 57.9% of those treated with LTG. However, with VGB total remission of the crises was achieved in 40% and with LTG in 13% of cases. Vigabatrin is more effective than lamotrigine in suppressing crises in children with partial crises (44% as compared with 9%). In children with generalize crises treated with LTG there was a reduction of > 50% in 69% of cases and with VGB in 46% (p = 0.02) but total suppression of crises was also seen more often with VGB (32% as compared with 19%, p = 0.12). Both drugs were well tolerated. In only one child treated with VGB and one treated with LTG did this treatment have to be suspended, in both cases due to psychotic reactions. No significant relationship was seen between dosage and serum levels, nor between serum levels and efficacy or side-effect. However, determinations of serum levels may be useful to detect excessively high levels of LTG which may lead to side-effects, especially when used in polytherapy.