Abstracts

The anticonvulsive effect of melatonin has been reported clinically and experimentally. However, most of clinical reports are based on relatively low dose administration (3-10mg/d) and small number of patients. We applied high dose melatonin therapy for treatment of extremely intractable epilepsy in childhood in order to evaluate clinical efficacy of high dose melatonin in treating those patients. Among 13 patients (2 to 20 years old) enrolled in this study, 12 patients were classified into secondary generalized epilepsy. 9 of them had West syndrome in infancy and their seizures had not been controlled since then. 1 patient was classified into cryptogenic localization-related epilepsy. All patients had daily seizures in spite of intensive treatment with multiple drugs and moderate to severe mental retardation. After receiving an informed consent from the parents and an approval of local ethical committee, melatonin was added to the baseline anti-epileptic drugs with gradual increase to 1 mg/kg/day (15mg to 45mg/day), that was taken at every night. Seizure frequency and side effects were monitored. 5 patients showed significant decrease in seizure frequency in the course of melatonin administration. Among them, a patients who had infantile spasms showed complete disappearance of spasms and hypsarrhythmia. However, spasms re-appeared after 2.5 months later. The rest of patients showed continuous decrease in seizure frequency. None of patients studied showed side effects or sleepiness. High dose melatonin therapy may be considered as one of choice for treatment of extremely intractable epilepsy, since 38% of such patients responded partially after administration of melatonin.