Monday, April 13, 2009

Combined treatment

I found this abstract from an article courtesy of Sage Publications (thanks, Danielle!)...

Combined Treatment With Vigabatrin and Topiramate in West Syndrome

The clinical and electroencephalographic (EEG) response to combined therapy with vigabatrin and topiramate was evaluated in five patients ages 7 to 15 months affected by West syndrome in an open-label trial. Four patients had cryptogenic and one patient had symptomatic (tuberous sclerosis) West syndrome. In cryptogenic patients who failed to respond to pyridoxine, vigabatrin was titrated to 80 to 100 mg/kg. Because control of infantile spasms or an EEG improvement was not obtained with vigabatrin treatment, topiramate was added (3-3.8 mg/kg/day). In all patients, the combined therapy with topiramate and vigabatrin achieved a rapid and complete normalization of infantile spasms, and in three patients with cryptogenic West syndrome, the EEG also became normal. In only one patient, transient anorexia was observed. This drug combination led to rapid neurodevelopmental normalization in cryptogenic patients. The results are promising and justify more trials in larger numbers of children with West syndrome. (J Child Neurol 2004 ; 19 :385-386).

Sabrina Buoni
Department of Pediatrics, Obstetrics and Reproductive Medicine Section of Pediatrics Policlinico Le Scotte University of Siena
Raffaella Zannolli
Department of Pediatrics, Obstetrics and Reproductive Medicine Section of Pediatrics Policlinico Le Scotte University of Siena
Mirella Strambi
Department of Pediatrics, Obstetric and Reproductive Medicine Section of Preventive Pediatrics Policlinico Le Scotte University of Siena
Alberto Fois
University of Siena, Siena Italy



A veteran IS mommy brought up this combo after one of my most recents posts. I had commented on the absence of clusters while Austin was on the vigabatrin. I thought it was definitely worth researching...and was surprised to have found this. I printed it to take with me to our epi appointment Wednesday.

I honestly hate the thought of Austin being on vigabatrin...and even though this study included only five patients...it's worth discussing.

3 comments:

baby trevor's mommy said...

Definately worth discussing! Now I'm like...maybe I should refill our Vig again? Ugh...

I suppose we'll cocktail Banz & Top...

and if that fails I'll bring up the Vig/Top combo.

I've always been SO contra to cocktailing...I don't know why...

Ugh...

Crossing fingers for you guys!

(((big huge hugs))))

...danielle

blogzilly said...

I asked our NP about why Keppra added to Topamax instead of Vig? No real answer. But the Vig/T combo sounds reasonable to ask your doc about for sure.

lizcgorman said...

Thanks so much for sharing that. I was about to give up on Vig and Topamax is what we were planning to try next, but now I will insist on trying them together before we wean the Vig.
Thanks!
Liz, Maddie's mama