Introduction
Previous research suggests that amantadine could be effective as an antiepileptic drug. We evaluate the use of the drug in children with refractory generalised epilepsy.
Method
Retrospective study of children with developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (D/EE-SWAS) or generalised epilepsy with refractory absence seizures treated with amantadine at a paediatric hospital in Madrid, Spain, over a 3-year period.
Results
We studied 12 children treated with amantadine for refractory epilepsy at a median age of 9.5 years (range, 3–11) and a median disease duration of 5 years (range, 1–8). Before initiation of amantadine, the patients had received 9.4 antiepileptic drugs on average (range, 6–14), and 9 had been placed on a ketogenic diet. Brain MRI displayed no structural lesion in any patient, except for one with a thalamic lesion. All patients had idiopathic epilepsy, and MRI results were normal. Five were diagnosed with D/EE-SWAS, and 7 had generalised epilepsy with refractory absence seizures (5 with refractory absence epilepsy, one with eyelid myoclonia with absence seizures, and one with Lennox–Gastaut syndrome). Amantadine was added to other antiepileptic drugs (mean number of drugs administered, 2.7) at a mean dose of 5.6mg/kg/day, with a maximum dose of 300mg/day. In the group with D/EE-SWAS, amantadine therapy achieved EEG activity normalisation and seizure control (myoclonic and absence seizures) in 80% (4/5). Among the patients with refractory epilepsy, only one (14.2%) achieved seizure control (75–99% response). One patient (10%) developed adverse effects (irritability and insomnia), leading to withdrawal of amantadine.
Conclusion
Amantadine is an effective and safe treatment for drug-resistant generalised epilepsy, especially in patients with D/EE-SWAS.
