Gabapentin in the treatment of refractory partial epilepsy in children with intellectual disability.
Gabapentin tames seizures equally in kids with ID, but those under ten with attention problems may show new tantrums or hyperactivity.
01Research in Context
What this study did
Doctors added gabapentin to the seizure drugs of children with intellectual disability.
They watched seizure counts and side-effects before and after starting the drug.
All kids had hard-to-treat partial epilepsy and kept taking their usual medicine.
What they found
Seizures dropped about the same for kids with and without ID.
Children under ten with attention problems showed more anger, hyperactivity, or tantrums.
The pill helped seizures but could stir up behavior in younger kids.
How this fits with other research
Bennett et al. (1998) saw the opposite pattern with zonisamide: it worked much better in typical kids than in kids with ID.
The difference is drug chemistry, not study style. Gabapentin calms nerves without extra cognitive load, while zonisamide seems to lose power when ID is present.
Alvarez et al. (1998) warn that old drugs like phenobarbital dull thinking. Gabapentin joins their list of newer, safer choices, but the new warning is to watch behavior in under-tens.
Gaily et al. (1998) give similar numbers with oxcarbazepine: about half of children with ID gain good seizure control, but side-effects still happen.
Why it matters
You now know gabapentin is an equal-opportunity seizure reducer, yet age and attention issues raise behavior risk. Share this with the prescribing doctor so you can track acting-out early. Pair the med with solid behavior plans and data sheets for hyperactivity or aggression. If the client is under ten and already impulsive, plan extra prompts and breaks the first month after the dose starts.
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02At a glance
03Original abstract
Twenty-six children with intellectual disability and six normal children, all suffering from refractory partial seizures, received open-label gabapentin (range = 10-50 mg kg(-1) day(-1); mean = 26.7 mg kg(-1) day(-1) as an add-on medication to their antiepileptic drug regimen. Mean seizure frequency during baseline was 9.5 seizures per week. Both groups had a significant reduction in seizure frequency. Response scores and response ratios did not differ between the intellectually disabled and normal groups (1.67+/-0.67 and 1.25+/-0.69, P = 0.697, and -0.400+/-0.089 and -0.283+/-0.159, P = 0.961, respectively). Behavioural side-effects were more likely to occur in patients with intellectual disability in comparison with the mentally normal group (P = 0.0107). In the present patient population, patients younger than 10 years of age, all of whom had intellectual disability, were more likely to have side-effects than those older than 10 years of age. Observed adverse effects, which were generally mild, occurred in patients with baseline intellectual disability, attention deficit disorder and behavioural problems. Behavioural adverse effects warranted discontinuation of the medication in only three patients. The severity of intellectual disability (mild versus moderate or severe) did not affect the extent of the response or the occurrence of side-effects. It is concluded that gabapentin is equally effective as an add-on medication against partial seizures in patients with or without intellectual disability. However, children with intellectual disability who also are less than 10 years of age with baseline attention deficit appear to be at a higher risk of behavioural side-effects.
Journal of intellectual disability research : JIDR, 1998 · doi:n/a