Carbamazepine and benzodiazepines in combination--a possibility to improve the efficacy of treatment of patients with 'intractable' infantile spasms?
Therapeutical efforts in epilepsies with infantile spasms (IS) often show unsatisfying results, especially if neurological impairments are found. In a clearly negatively selected group of 24 children with IS and 10 patients with symptomatic myoclonic-astatic epilepsies--pretreated without success with ACTH and/or benzodiazepines (BDZ) alone or combined with other anticonvulsants--we tried a two-drug therapy of BDZ with carbamazepine (CBZ). Dosage of both drugs was within the usual range. In a follow-up period of 1-5 years, 8 of the IS patients and 4 of those with myoclonic-astatic seizures became seizure-free; furthermore, 6 children showed a marked reduction in their seizure frequency: 3 more than 80%, 3 more than 50%. Besides the fact that the patients did not develop a so-called escape-phenomenon--as often seen in therapy with benzodiazepines--they also showed fewer and less intensive side-effects. Without optioning for antiepileptic polytherapy in general, we conclude that in cases of "intractable" IS the combination of BDZ with CBZ might be more successful than the single drug. To confirm these preliminary findings further controlled studies have to be carried out.
Department of Pediatrics, University Clinics of Vienna, Austria.
E
E
Tatzer
C
C
Groh
R
R
Müller
A
A
Lischka
D002220:Carbamazepine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002998:Clonazepam / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009567:Nitrazepam / Q000008:administration & dosage*; D013036:Spasms, Infantile / Q000188:drug therapy*
D002220:Carbamazepine; D002998:Clonazepam; D009567:Nitrazepam