Ng Yu-tze, Collins Stephen D
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.
Neurotherapeutics. 2007 Jan;4(1):138-44. doi: 10.1016/j.nurt.2006.11.002.
Catastrophic childhood epilepsies such as infantile spasms (IS), progressive myoclonic epilepsy, and Lennox-Gastaut syndrome (LGS) are rare but debilitating and frequently persist into adulthood. Early, targeted use of medications that have demonstrated efficacy in the management of LGS or its associated epilepsies may simplify the patient's treatment regimen and reduce the incidence of adverse events. Key to the overall benefit to the patient is to maximize seizure control while minimizing adverse effects, especially behavioral and cognitive problems. Clobazam has demonstrated clinical benefit and has been administered safely in more than 50 European studies in which data were reported on greater than 3000 pediatric and adult patients with epilepsy, 300 of whom were diagnosed with LGS; therefore, its use is now being investigated in the U.S. This review will explore the use of clobazam in the treatment of epilepsy, particularly with regard to its potential benefit in LGS. Though not currently approved for use in the U.S., a program is underway to gain Food and Drug Administration approval for the treatment of pediatric and adult patients with refractory epilepsy, specifically in LGS. A phase 2 study will be completed in late 2006 to investigate the safety and efficacy of clobazam as adjunctive therapy in 68 pediatric and adult patients with LGS.
灾难性儿童癫痫,如婴儿痉挛症(IS)、进行性肌阵挛癫痫和伦诺克斯-加斯东综合征(LGS)虽罕见,但会使人衰弱,且常持续至成年期。早期有针对性地使用已证明对LGS或其相关癫痫有效的药物,可能会简化患者的治疗方案并降低不良事件的发生率。对患者总体受益的关键在于在将不良反应(尤其是行为和认知问题)降至最低的同时,最大程度地控制癫痫发作。氯巴占已显示出临床益处,并且在50多项欧洲研究中已安全给药,这些研究报告了3000多名癫痫患儿和成人患者的数据,其中300人被诊断为LGS;因此,目前美国正在对其使用情况进行研究。本综述将探讨氯巴占在癫痫治疗中的应用,特别是其在LGS中的潜在益处。尽管目前在美国未获批准使用,但正在开展一项计划以获得美国食品药品监督管理局对治疗难治性癫痫患儿和成人患者(特别是LGS患者)的批准。一项2期研究将于2006年末完成,以调查氯巴占作为辅助疗法在68例LGS患儿和成人患者中的安全性和有效性。