Felbamate for infantile spasms syndrome resistant to first‐line treatments

• Published in: Developmental medicine and child neurology 2020-05, Vol.62 (5), p.581-586
• Main Authors: Dozières‐Puyravel, Blandine, Nasser, Hala, Bellavoine, Vanina, Ilea, Adina, Delanoe, Catherine, Auvin, Stéphane
• Format: Article
• Language: English
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.14427

Aim To analyse the effects of felbamate in refractory infantile spasms/West syndrome. Method We conducted a 10‐year retrospective study of infants (including all infants younger than 18mo) treated with felbamate for electroencephalography‐recorded epileptic spasms persisting after first‐line treatment. Results In total, 29 infants (17 males, 12 females) were included in the study. Felbamate was initiated at a mean age of 13.8 months (range 4.5–66mo) after sequential administration or combination of vigabatrin and oral steroids; a ketogenic diet was implemented in 23 infants. Eight infants became spasm‐free at a mean dose of 34.6mg/kg/day felbamate (range 26–45mg/kg/day). Mean duration of felbamate use was 19 months (range 1–67mo) for the 19 infants whose treatment was terminated. No severe side effects were observed. Reversible neutropenia led to withdrawal of felbamate in six patients. One spasm‐free patient demonstrated recurrence when felbamate was withdrawn. Interpretation N‐methyl‐d‐aspartate receptors with felbamate controlled epileptic spasms in eight infants resistant to first‐line treatment should be targeted. What this paper adds Eight infants resistant to first‐line treatment were spasm‐free when treated with felbamate. No severe side effects were observed with a mean exposure time of 19 months. Mild, reversible neutropenia was experienced in 6 of 29 patients when felbamate was withdrawn. This article is commented on by Lux on pages 541–542 of this issue.