Abstracts A23

415 Round table: New anti-epileptic drugs A ARZIMANOGLOU Paris

Tiagabine (TGB) is a novel anti-epileptic drug, developed for its ability to inhibit GABA reuptake. It selectively inhibits GAT-1 which is the predominant transport in neurons of the cortex and hippocampus. Thus TGB increases extracellular concentrations of GABA.

Paediatric pharmacokinetic data show a similar pat- tern to that seen in adults. Children taking an enzyme- inducing anti-epileptic drug (phenytoin or carbamaze- pine) eliminate TGB more rapidly than those taking a non-inducing anti-epileptic drug. In most paediatric studies initial dosing of 0.1 mg/kg/day to 0.25mg/kg/ day have been used. In a few cases, doses up to 1.5 mg/ kg/day were used, taking into account concomitant therapy interactions.

In the treatment of partial epilepsies, controlled studies provided efficacy results similar to other new anti- epileptic drugs. Efficacy and safety of TGB in children continue to be investigated. Data in children under 5 years of age remain to be obtained.

Despite a profile similar to other new anti-epileptic drugs, data from everyday clinical practice are still lacking. A larger use of the drug will allow a better understanding of its role in the treatment of childhood epilepsies.

051 Starting an epilepsy school for families: A process of learning to know the needs T BALSLEV, D MYGIND, A BERNSEN Division of Pediatric Neurology,, Department of caediatrics, Skejby Hospital, Arhus University Hospital, Arhus, Denmark

The increasing amount of information available to families on the inter-net and from other sources, some of which may be difficult to interpret, prompted us to introduce a brief and basic course in paediatric epilepsy for parents of children with newly onset seizures. This is a report of the initial experiences during development of the form and content of the course.

The purpose of the course was to optimize under- standing of epilepsy and its consequences for the individual and the family. Separate sessions for parents and children 6-14 years were offered. Siblings in this age- group were also offered participation. The children were asked to draw how they felt they looked during a seizure and afterwards the impact of their epilepsy on everyday life was discussed. Simple concepts in aetiology, prog- nosis and treatment were introduced. Before and after the course the children completed a questionnaire on epilepsy.

The parental course included sessions on aetiology, types of epilepsy, work-up and treatment for paediatric patients. Videorecordings of seizures were used to facilitate discussions for children as well as parents.

The duration of the course was 2+2 hours. After each course the parents rated the value of the sessions in a questionnaire with open-ended as well as specific questions.

All parents taking part in the course found it inspiring, would recommend it to others and wished to attend it again in l-2 years time. Sessions on aetiology, types of epilepsy, work-up and treatment were found to be satisfactory by most of the parents. A total of 46% of parents wished to hear more about common problems in everyday life, day care, kindergarten and school, or insurance and travel.

The wide range in age among the children made teaching challenging. Most children felt that the course was interesting, and in particular, many found it valuable to listen to the experiences of other children.

Children and families of children with newly onset epilepsy may benefit from attending an epilepsy school with a tailored programme, carefully selected by the caregivers.

052 Efficacy of anti-epileptic drugs in children with Angelman syndrome associated with 15411-l 3 deletion T BALSLEV, j R OSTERCAARD Department of Pediatcics, Skejby Hospital, irhus University Hospital, Arhus, Denmark

The medical records of 20 Angelman syndrome patients aged 3-15 years were reviewed, and parental question- naires were completed. All the children had epilepsy, and were treated with a maximum of three anti-epileptic drugs at a time. Up to six different anti-epileptic drugs were administered to any patient. The drugs were given as monotherapy in 24 instances and as add-on therapy in 29 instances. The efficacy within 6 months of treatment was recorded as seizure freedom, > 50% decrease in seizures, < 50% decrease in seizures, unchanged or worsened.

Seizure freedom was achieved within 6 months of treatment in seven (88%) of eight patients treated with nitrazepam. Nitrazepam was given as monotherapy in two patients and as add-on therapy in six patients. The dose was relatively low: 0.1-0.25 mg/kg/day. Seizure freedom was achieved in all five patients treated with clobazam, in four (80%) of five patients treated with clonazepam, and in four (25%) of 16 patients treated with valproic acid. Side-effects were rarely reported in the patients treated with these drugs, and worsening of seizures was not seen. Worsening of seizures was seen in all five patients treated with oxcarbazepine, all four patients treated with carbamazepine and all three patients treated with vigabatrin. Lethargy was common.

Nitrazepam, clobazam and clonazepam are highly effective in epilepsy in Angelman syndrome, and associated with only a few side-effects. Carbamazepine, oxcarbazepine and vigabatrin are likely to worsen seizures and provoke lethargy in the patients and should be avoided.