Abstracts

Rationale: The combination of lamotrigine and valproate-divalproex sodium (VPA-LTG) is effective in the treatment of refractory epilepsy in children and adults, as previously demonstrated (Thome-Souza & Valente 2013). Machado et al. (2011) suggested that the association of VPA-LTG with clobazam (CLB) seems to be more effective than with other benzodiazepines. In this study, we compared the efficacy of VPA-LTG, in a large sample of patients with refractory epilepsy, with different benzodiazepines. Methods: Seventy-one patients (mean of 13.9 years; 40.8 % female) with refractory epilepsy and no indication for surgical intervention were evaluated. Sixty-four patients were eligible for the study. They were classified in three subgroups: 27 (42.2%) using VPA-LTG alone; 21 (32.8%) using VPA-LTG and CLB; and 16 (25%) using VPA-LTG and other BZD. In order to compare demographic data among groups, we used Chi-square and ANOVA. Efficacy in distinct groups was evaluated using chi-square and Fisher's exact test. Results: Twenty-six patients (40.6%) had lesional epilepsy; 35 (54.7%) had undetermined; and 3 (4.7%) had genetically determined epilepsy. There were no differences considering seizure type; frequency and etiology among groups. At the end of the first year of follow-up, the efficacy of the VPA-LTG combination in controlling seizures was > 75% in 29 (40.8 %) patients and was > 90% in 22 (30.4%). No differences were observed comparing the three groups - VPA-LTG; VPA-LTG-CLB and VPA-LTG-other BZD (p=0.221 [>75%] and p=0.591 [>90%]).The efficacy in patients with VPA-LTG- CLB compared to other two groups showed similar results (p=0,365 [>75%] and p=0,783 [>90%]). Conclusions: FDA has recently approved Clobazam and there is renewed interest for this old and effective drug. It is well known that Clobazam is a good option as adjunctive therapy in refractory epilepsy. However, in this study, we observed that the combination of VPA and LTG is effective, regardless of the benzodiazepine used. These are preliminary results and larger series are necessary in order to confirm these results.