维加巴丁
儿科
随机对照试验
随机化
医学
安慰剂
癫痫
结节性硬化
贝利婴儿发育量表
神经认知
麻醉
抗惊厥药
心理学
外科
精神科
认知
精神运动学习
病理
替代医学
作者
E. Martina Bebin,Jurriaan M. Peters,Brenda E. Porter,Tarrant McPherson,Sarah O’Kelley,Mustafa Şahin,Katherine S. Taub,Rajsekar R. Rajaraman,Stephanie C. Randle,W. McClintock,Mary Kay Koenig,Michael Frost,Hope Northrup,Klaus Werner,Danielle Nolan,Michael Wong,Jessica Krefting,Fred J. Biasini,Kalyani Peri,Gary Cutter,Darcy A. Krueger
摘要
Objective This study was undertaken to test the hypothesis that early vigabatrin treatment in tuberous sclerosis complex (TSC) infants improves neurocognitive outcome at 24 months of age. Methods A phase IIb multicenter randomized double‐blind placebo‐controlled trial was conducted of vigabatrin at first epileptiform electroencephalogram (EEG) versus vigabatrin at seizure onset in infants with TSC. Primary outcome was Bayley Scales of Infant and Toddler Development, Third Edition (Bayley‐III) cognitive assessment score at 24 months. Secondary outcomes were prevalence of drug‐resistant epilepsy, additional developmental outcomes, and safety of vigabatrin. Results Of 84 infants enrolled, 12 were screen failures, 4 went straight to open label vigabatrin, and 12 were not randomized (normal EEG throughout). Fifty‐six were randomized to early vigabatrin (n = 29) or placebo (n = 27). Nineteen of 27 in the placebo arm transitioned to open label vigabatrin, with a median delay of 44 days after randomization. Bayley‐III cognitive composite scores at 24 months were similar for participants randomized to vigabatrin or placebo. Additionally, no significant differences were found between groups in overall epilepsy incidence and drug‐resistant epilepsy at 24 months, time to first seizure after randomization, and secondary developmental outcomes. Incidence of infantile spasms was lower and time to spasms after randomization was later in the vigabatrin group. Adverse events were similar across groups. Interpretation Preventative treatment with vigabatrin based on EEG epileptiform activity prior to seizure onset does not improve neurocognitive outcome at 24 months in TSC children, nor does it delay onset or lower the incidence of focal seizures and drug‐resistant epilepsy at 24 months. Preventative vigabatrin was associated with later time to onset and lower incidence of infantile spasms. ANN NEUROL 2024;95:15–26
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