Treatment of Infantile Spasms and Lennox‐Gastaut Syndrome with Clonazepam (Rivotril®)

Vassella, F; Pavlincova, E; Schneider, H.; Rudin, H. J.; Karbowski, K

doi:10.1111/j.1528-1157.1973.tb03953.x

Cited by 55 publications

(17 citation statements)

References 7 publications

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“…BZDs reduce the inhibitory output of the reticular neurons and, therefore, prevent absence seizure activity. BZDs have been used as acute parenteral or rectal agent (diazepam, lorazepam, midazolam) or for chronic oral use (clobazam, clonazepam, clorazepate, nitrazepam) (Vassella et al 1973; Muller and Lenard 1988; Trimble 2002). BZDs remain, in most guidelines, the treatment of choice for acute or subacute seizures, but should be avoided, particularly the 1,4-BZDs, for prolonged therapy because of tolerance, somnolence, risk of withdrawal seizures, increased bronchial or oral secretions, etc.…”

Section: Chronic Medical Treatmentmentioning

confidence: 99%

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Treatment of Lennox-Gastaut syndrome: overview and recent findings

Rijckevorsel¹

2008

NDT

118

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Lennox-Gastaut syndrome (LGS) is a rare, age-related syndrome, characterized by multiple seizure types, a specifi c electro-encephalographic pattern, and mental regression. However, published data on the etiology, evolution, and therapeutic approach of LGS are contradictory, partly because the precise defi nition of LGS used in the literature varies. In the most recent classifi cation, LGS belongs to the epileptic encephalopathies and is highly refractory to all antiepileptic drugs. Numerous treatments, medical and non-medical, have been proposed and results mostly from open studies or case series have been published. Sometimes, patients with LGS are included in a more global group of patients with refractory epilepsy. Only 6 randomized double-blind controlled trials of medical treatments, which included patients with LGS, have been published. Overall, treatment is rarely effective and the fi nal prognosis remains poor in spite of new therapeutic strategies. Co-morbidities need specifi c treatment. This paper summarizes the defi nition, diagnosis and therapeutic approach to LGS, including not only recognized antiepileptic drugs, but also "off label" medications, immune therapy, diet, surgery and some perspectives for the future.

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Section: Chronic Medical Treatmentmentioning

confidence: 99%

“…PB may worsen behavioral problems (Delanty and French 1998) in children and has cognitive and sedative side effects. These AEDs should be avoided even though they can control tonic-clonic seizures (Vassella et al 1973; Muller and Lenard 1988). …”

Section: Chronic Medical Treatmentmentioning

confidence: 99%

Treatment of Lennox-Gastaut syndrome: overview and recent findings

Rijckevorsel¹

2008

NDT

118

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“…Clonazepam is a benzodiazepine medication indicated for treatment of most types of epilepsy in children and adults 38 . An open‐label study of 37 children included 24 children with infantile spasms and 13 children with LGS whose seizures had been resistant to other treatment 39 . Efficacy was based on the frequency of seizures and EEG results.…”

Section: Fda‐approved Medicationsmentioning

confidence: 99%

The efficacy and tolerability of pharmacologic treatment options forLennox‐Gastaut syndrome

2014

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SUMMARYLennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy that appears in childhood.LGS is characterized by a slow spike-wave pattern on electroencephalogram (EEG), cognitive impairment, and multiple seizure types. This mixture of seizure types, along with the need to use more than one type of medication, makes LGS one of the most complicated epilepsies to treat successfully. Recent developments in approved therapies for the treatment of LGS offer physicians more options, but also make developing a treatment strategy that minimizes adverse events more challenging. There are currently 5 treatment options for LGS: felbamate, lamotrigine, topiramate, rufinamide, and clobazam, and several others that are used off-label, each of which has benefits and limitations. There are several factors that must be considered when determining which medication to use when treating patients with LGS, including efficacy, which is assessed by seizure frequency, tolerability, and the anticipated duration of treatment. In this article, data supporting current treatment options are discussed, and important considerations about the treatment of LGS are reviewed.

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“…Se han realizado ensayos clínicos aleatorizados controlados, en pacientes con el cuadro ya establecido de encefalopatía epiléptica, para determinar la eficacia y seguridad de algunos fármacos antiepilépticos (FAE) como lamotrigina, felbamato, topiramato, clobazam, rufinamida; fármacos que han sido aprobados por la FDA para su uso en SLG (17)(18)(19)(20)(21)(22)(23)(24). Postura sustentada en una revisión de Cochrane de estudios aleatorizados controlados que concluyó que lamotrigina y felbamato redujeron significativamente la frecuencia de todos los tipos de crisis respecto a placebo (32% vs 9% [P=0,02]; y 19% vs 4% [P=0,002], respectivamente) (17,18).…”

Section: Resultados De Ensayosunclassified

“…Dentro de este grupo, el clobazam es el fármaco de elección para terapia de adición, por tener un perfil de mayor seguridad: menor somnolencia, menor interacción medicamentosa, rápido inicio de acción, vida media más larga, amplio espectro; sin embargo, puede incrementar la espasticidad en pacientes con daño neurológico extenso perinatal (21)(22)(23).…”

Section: Rev Neuropsiquiatr 81(2) 2018unclassified

Síndrome de Lennox Gastaut. Aproximación diagnóstica y avances terapéuticos: Fármacos antiepilépticos, Canabidiol y otras alternativas.

Herrera

Burneo²

2018

Rev Neuropsiquiatr

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El Síndrome de Lennox Gastaut es una encefalopatía epiléptica catastrófica de inicio en la infancia con características electro-clínicas definidas de la siguiente manera: 1) presencia de múltiples tipos de crisis epilépticas especialmente tónicas; 2) deterioro cognitivo asociado a cambios conductuales; 3) presencia de complejos punta-onda lenta generalizados en el electroencefalograma (EEG) y paroxismos generalizados de actividad rítmica rápida durante el sueño. Su etiología puede ser estructural o genética (antes denominadas sintomáticas y criptogénicas, respectivamente). El diagnóstico inicial puede ser difícil ya que con frecuencia no se identifican todos los criterios al comienzo del cuadro y el diferencial considera otros síndromes epilépticos de inicio en la infancia, tales como las epilepsias mioclónicas. El tratamiento es muy complejo, se carece de guías definidas de práctica clínica, por lo cual la experiencia de expertos es relevante. Se sugiere inicio de medicación con valproato. Lamotrigina, felbamato, topiramato, rufinamida y clobazam son los fármacos de elección de segunda línea aprobados por la Administración Federal de Alimentos y Drogas de los Estados Unidos. (FDA). El manejo quirúrgico incluye cirugía resectiva y callosotomía total o parcial. Otras alternativas son estimulación del Nervio Vago, dieta cetogénica, estimulación cerebral profunda y el uso médico de cannabis.

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Treatment of Infantile Spasms and Lennox‐Gastaut Syndrome with Clonazepam (Rivotril®)

Cited by 55 publications

References 7 publications

Treatment of Lennox-Gastaut syndrome: overview and recent findings

Treatment of Lennox-Gastaut syndrome: overview and recent findings

The efficacy and tolerability of pharmacologic treatment options forLennox‐Gastaut syndrome

Síndrome de Lennox Gastaut. Aproximación diagnóstica y avances terapéuticos: Fármacos antiepilépticos, Canabidiol y otras alternativas.

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