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Severe Myoclonic Epilepsy in Infancy: Toward an Optimal Treatment

Epilepsy Center for Children and Youth Pulderbos, Belgium, Department of Neurology-Child Neurology University Hospital Antwerp, Edegem, Belgium, Department of Molecular Genetics University of Antwerp Antwerp, Belgium, berten.ceulemans{at}revapulderbos.be

Marc Boel, MD

Epilepsy Center for Children and Youth Pulderbos, Belgium, Department of Child Neurology University Hospital Gasthuisberg, Leuven, Belgium

Lieve Claes, MSc, PhD

Department of Molecular Genetics University of Antwerp Antwerp, Belgium

Lina Dom, MD

Queen Paola Children's Hospital Antwerp, Belgium

Herman Willekens, MD

A.Z. St-Lucas Ghent, Belgium

Paul Thiry, MD

St-Oda Institute Overpelt, Belgium

Lieven Lagae, MD, PhD

Epilepsy Center for Children and Youth Pulderbos, Belgium, Department of Child Neurology University Hospital Gasthuisberg, Leuven, Belgium

Severe myoclonic epilepsy in infancy, or Dravet syndrome, is one of the catastrophic epilepsy syndromes. In the past, treatment was mainly based on valproate and phenobarbital. Recently, some of the new antiepilepsy drugs, such as topiramate and stiripentol, have been shown to be promising in the treatment of this epilepsy syndrome. The treatment regimen of 12 children with Dravet syndrome and proven mutations in the alpha subunit of the sodium channel SCN1A is reported here. Five patients on the "traditional" treatment regimen are compared with seven children on an "optimal" treatment regimen based on a combination of valproate and topiramate. With respect to the literature and our own experience, we propose guidelines for "optimal" treatment of children with severe myoclonic epilepsy in infancy. This includes prevention of hyperthermia, rigorous treatment of fever, avoiding stressful situations, maintenance treatment based on a combination of only two antiepilepsy drugs (ie, valproate and topiramate), and a strict acute seizure treatment based on benzodiazepines. To prevent long-lasting periods of status epilepticus, this acute seizure treatment must be taught to parents and caregivers. ( J Child Neurol 2004;19:516—521).

Journal of Child Neurology, Vol. 19, No. 7, 516-521 (2004)
DOI: 10.1177/08830738040190070701


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