Abstracts

Gabapentin (GBP) was first introduced as an anticonvulsive agent in 1993, with an indication for use as an adjunctive therapy for patients with complex partial epilepsy, with or without secondary generalization. Although in adults GBP been shown to be effective in randomized, double-blinded, placebo controlled studies, the effectiveness of GBP monotherapy in pediatrics has not yet been established. This retrospective review was conducted to evaluate both the efficacy and safety of GBP monotherapy in pediatric epilepsy. We conducted a retrospective review of GBP treatment in patients followed through the Massachusetts General Hospital pediatric epilepsy program from January 2002-March 2004. The data include patients that were started on GBP as first anticonvulsant medication in new onset epilepsy, as well as patients who were initially on combination therapy with GBP and other ACD and then converted to monotherapy with GBP. Data collected included patient age, gender, seizure type and etiology, GBP dosages, reported side effects, and effect of GBP on seizure frequency (as percentage reduction from baseline prior to GBP treatment). Twelve patients were treated with GBP as monotherapy during the study period. These had complex partial epilepsy, with or without secondary generalization. Seizure etiology included Sturge Weber Syndrome, Tuberous Sclerosis Complex, and cortical dysgenesis; 60% of the subjects had abnormal brain MRI findings. Dosage of GBP was based on mg/kg for each patient, with an average dose of 45 mg/kg. GBP was discontinued in one patient who developed behavioral problems. Of the twelve patients on GBP monotherapy, nine (75%) became seizure free, and two reported a greater than 50% reduction in seizure frequency. One patient with a history of hypoxic ischemic injury following prematurity continues on GBP monotherapy, but also receives frequent diazepam administration due to seizure activity. In our population of children with epilepsy, GBP appears to be an effective and well tolerated medication in the treatment of complex partial epilepsy. Gabapentin can be effective as monotherapy in pediatric epilepsy, including symptomatic epilepsies.