Abstracts

RATIONALE: Tiagabine (TGB), a specific inhibitor of GABA uptake into neurons and glia, is effective in partial epilepsy. Recently nonconvulsive status epilepticus (NCSE) has been described in patients on TGB. METHODS: Since TGB was licensed in february 1999, 53 unresponsive partial epileptic patients underwent to TGB add-on therapy. TGB was titrated in 6-8 weeks starting with 2.5 mg and increasing until maximun tolerated dose or minimum effective dose was reached. Concomitant AEDs were unchanged. RESULTS: Four patients (3 F,1 M), aged 30?11, suffering from cryptogenic (2), and remote symptomatic (2) epilepsy complained of an arising symptomatology during the titration phase (1 case: 22.5 mg), and in maintenance phase (2 case: 30 mg; 1 case: 40 mg). Concomitant AEDs were CBZ, CBZ and LTG, LTG and VGB. Symptoms complained were defined as a status epilepticus and consisted in (i) lack of consciousness, looking around, and myoclonic jerks in orbicularis oris (he suffered from gelastic seizures); (ii) atypical absences (she suffered from partial secondary generalized seizures of frontal lobe); (iii) paroxysmal right arm hypotonia (she suffered from simple sensitive partial seizures in left arm); (iiii) irritability, anxiety, and aggressivity and destructive behaviour in post-ictal phase (she suffered from simple partial, complex partial, and secondary generalized seizures). EEG patterns showed (i) marked slowing of background activity in all patients; (ii) right frontal sharp-waves widespreading and continuous generalized atypical spike-and-waves (his baseline EEG did not show specific abnormalities); (iii) 2-12 secs synchronous diffuse bursts of 2-2.5 Hz spike-and-waves (EEG baseline pattern showed specific localised abnormalities in F-T, P-T, and F regions). In all cases TGB discontinuation was followed by complete and sustained electroclinical remission. CONCLUSIONS: This observation confirms the putative role of TGB in determining a NCSE in selected patients. NCSE was characterized by generalized epileptic EEG discharges and seizures before never had. TGB doses, length of treatment, type of epilepsy did not appear to relate with the arise of NCSE.