Infantile spasms with hypsarrhythmia are refractory to the usual antiseizure agents; glucocorti-coids are commonly used. Vigabatrin (g-vinyl GABA) is efficacious in comparison to placebo, although constriction of visual fields has been reported in some adults treated with vigabatrin. Vigabatrin has orphan drug status in the U.S. for the treatment of infantile spasms and is available elsewhere.
Lennox-Gastaut syndrome is a severe form of epilepsy that usually begins in childhood and is characterized by cognitive impairments and multiple types of seizures including tonic-clonic, tonic, atonic, myoclonic, and atypical absence seizures. Lamotrigine is an effective and well-tolerated drug for this treatment-resistant form of epilepsy; addition of lamotrigine to other anti-seizure drugs may improve seizure control. Topiramate also has demonstrated efficacy in Lennox-Gastaut syndrome.
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