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Current therapeutic procedures in Dravet syndrome.
MedLine Citation:
PMID:  21504427     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Dravet syndrome is a highly pharmaco-resistant form of epilepsy. Valproate and benzodiazepines are the first-line treatment but are usually insufficient therapeutic options. Lamotrigine, carbamazepine and high doses of intravenous phenobarbital can aggravate seizures and should be avoided. Topiramate, levetiracetam, bromide and ketogenic diet also provide substantial efficacy as adjunctive therapy and procedures. Stiripentol is the only new drug to demonstrate efficacy when combined with valproate and clobazam, as shown in two independent double-blind controlled trials dedicated to Dravet children. In order to avoid side effects (mainly loss of appetite and loss of weight) resulting from the inhibition of cytochromes P450 by stiripentol, the prescribed doses of valproate and clobazam should be reduced. Stiripentol has a proper antiepileptic effect and enhances GABAergic neurotransmission by acting on the alpha-3 subunit of GABA(A) receptors. Stiripentol was approved as an orphan drug in Europe in 2007 for adjunctive therapy in Dravet syndrome. More than 500 Dravet patients have currently been satisfactorily treated and recent experiments in Japan have confirmed stiripentol's benefit. In practice, valproate should be initiated at the first onset of complicated febrile seizure in Dravet patients. Relapses justify the addition of clobazam and stiripentol when available. Topiramate and a ketogenic diet are alternatives in pharmaco-resistant cases.
Authors:
Catherine Chiron
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Developmental medicine and child neurology     Volume:  53 Suppl 2     ISSN:  1469-8749     ISO Abbreviation:  Dev Med Child Neurol     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0006761     Medline TA:  Dev Med Child Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  16-8     Citation Subset:  IM    
Copyright Information:
© 2011 The Author. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.
Affiliation:
Inserm, U663, Paris, Université Paris Descartes, Paris, France. catherine.chiron2@gmail.com
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