Abstracts

Rationale: Valproate and lamotrigine has been seen as an effective association in refractory epilepsy. Two recent studies (Machado et al. 2011; Thome-Souza & Valente 2011) demonstrated the efficacy of this association in drop attacks. Larger series are important in order to corroborate these findings. Herein, we describe a large series of patients with drop attacks and evaluate the efficacy in one-year follow up. Methods: We followed 60 patients with drop attacks, 39 (65%) were male and 21 (35%) females, ranged for 3 to 48 years (mean 13.3 years; median 10 years), 46 976.7%) patients under the age 18 years. Related to syndromic diagnosis: 26 had symptomatic generalized epilepsy (43.3%); 11 with probably symptomatic generalized epilepsy (18.3%); 16 with symptomatic partial epilepsy (26.7%); six with probably symptomatic partial epilepsy (10%), and one with idiopathic generalized epilepsy (1.7%). Fifty-six (93.3%) patients were taking valproate, lamotrigine and one benzodiazepine. Results: In the first year of follow up, we observed that out of 22 (36.7%) patients with focal epilepsy, six (27.3%) were seizure-free for drop attack, 14 (63.6%) had control > 75%, and two (9.1%) discontinued treatment due to adverse effects (skin rash). In the group of 38 (63.3%) patients with generalized epilepsy, 18 (47.4%) were seizure-free, nine (23.7%) had control > 75%., six (15.8%) control between 50-75%, one (2.6%) < 50%, and four (10.5%) discontinued treatment. There was no significant difference in efficacy related to the type of epilepsy (focal or generalized). Eight (13.3%) patients had Lennox-Gastaut Syndrome, and seven (87.5%) of these had superior efficacy to 75% in the control of drop attacks. Six (10%) patients discontinued treatment due to adverse effects (83.3%) or abandoned treatment (16.7%). (Figure 1) Conclusions: The association of valproate, lamotrigine, and one benzodiazepine is effective in controlling of drop attacks seizure, regardless of epilepsy syndrome.