Severe myoclonic epilepsy in infancy: toward an optimal treatment.
Severe myoclonic epilepsy in infancy, or Dravet syndrome, is one of the catastrophic epilepsy syndromes. In the past, treatment was mainly based on valproate and phenobarbital. Recently, some of the new antiepilepsy drugs, such as topiramate and stiripentol, have been shown to be promising in the treatment of this epilepsy syndrome. The treatment regimen of 12 children with Dravet syndrome and proven mutations in the alpha subunit of the sodium channel SCN1A is reported here. Five patients on the "traditional" treatment regimen are compared with seven children on an "optimal" treatment regimen based on a combination of valproate and topiramate. With respect to the literature and our own experience, we propose guidelines for "optimal" treatment of children with severe myoclonic epilepsy in infancy. This includes prevention of hyperthermia, rigorous treatment of fever, avoiding stressful situations, maintenance treatment based on a combination of only two antiepilepsy drugs (ie, valproate and topiramate), and a strict acute seizure treatment based on benzodiazepines. To prevent long-lasting periods of status epilepticus, this acute seizure treatment must be taught to parents and caregivers.
Ceulemans
Berten
B
Epilepsy Center for Children and Youth, Pulderbos, Belgium. berten.ceulemans@revapulderbos.be
Boel
Marc
M
Claes
Lieve
L
Dom
Lina
L
Willekens
Herman
H
Thiry
Paul
P
Lagae
Lieven
L
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D020190:Myoclonic Epilepsy, Juvenile / Q000188:drug therapy* / Q000473:pathology* / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015222:Sodium Channels / Q000235:genetics; D013315:Stress, Psychological; D016896:Treatment Outcome; D062547:Voltage-Gated Sodium Channel beta-1 Subunit
D000927:Anticonvulsants; C470379:SCN1B protein, human; D015222:Sodium Channels; D062547:Voltage-Gated Sodium Channel beta-1 Subunit; D001569:Benzodiazepines