Abstracts

Severe or chronic epileptic syndromes of childhood are known to affect cognitive or academic performances. In addition, incomplete seizure control is believed to be detrimental to development. Memantine may act as a neuroprotective, mild anticonvulsant, and cognitive enhancing drug in epileptic patients due to the pharmacological mechanism of action as an antagonist of NMDA receptor channels, and blocking the effects of glutamate on neurons. We report experience on patients with either cognitive impairment from severe epilepsy and/or continuing breakthrough seizures, using add-on therapy with Memantine. 13 patients (6 male, 7 female, average age 6 years, 4 months) with epilepsy and cognitive delay were given Memantine as add-on therapy with no other changes made to their antiepileptic drugs (AED) or their medications for behavior. The average dosage of Memantine was 5.4 mg/day (range 2.5 to 10 mg/day). 6/13 patients were having breakthrough seizures, mainly atypical absence seizures (ave. seizure freq. was 10.9 seizures/day, range 0.1 to 50 seizures/day). 7/13 patients had controlled seizures but had cognitive or motor dysfunction or attention difficulties. In 6/13 patients with continuing epilepsy, 2 became seizure-free over 2 months. 3 had decreased frequency of seizures (ave. seizure frequency after taking Namenda 0.4 seizures/day). Cognitive or functional improvements observed in all patients included improved attention (11/13), better motor planning skills (10/13), improved language complexity (10/13), or other global improvement (11/13) as assessed by parental or clinician observation. Memantine may be a therapeutic option to improve intractable seizures, and protect and enhance cognitive function in patients with epilepsy. The seizure frequency improvement after administering Namenda was most dramatic in children with atypical absence seizures. EEG correlation is still pending and further controlled studies are warranted.