Abstracts

This study aimed to prospectively evaluate the risks and benefits of valproate/divalproate and lamotrigine co-administration in a pediatric population with refractory epilepsy., Seventy-six patients received an association of valproate and lamotrigine according to Gubermann[acute]s criteria (1993). Results were established in accordance with seizure control, adverse effects and tolerability. Treatment was considered effective when seizure reduction [gt] 50% was obtained., Association of valproate and lamotrigine was considered effective in 69 (90.8%) of all patients. Total seizure control (seizure-free) was obtained in 45 (59.2%) patients. Although seizure control was considered unsatisfactory ([lt]50%) in the remaining patients, drop-attacks and secondarily generalized tonic-clonic seizures were reduced in nine (11.8%) patients, maintained on treatment. Tremor occurred in six (7.9%) patients; urinary incontinence and ataxia in one (1.3%). Skin rash occurred as an early manifestation in six (7.9%) patients, of which all had a previous history of hypersensitivity to anti-epileptic drugs. Reasons for treatment fall-out were unsatisfactory seizure control in five (6.6%) and adverse effects in three (3.9%)., In this series, seizure control was observed in most children with refractory epilepsy, some of which had a previous history of unsatisfactory response either to lamotrigine or to valproato, both in monotherapy or polytherapy. Adverse effects were infrequent, but skin rash was observed more frequently than in other series in which valproate or lamotrigine were used separately. However, this risk may be minimized by slow introduction and increase of the dosage of lamotrigine and by exclusion of patients with a previous history of hypersensitivity., (Supported by FAPESP 03/07724-2.)