Introdução: a cirurgia de epilepsia é uma opção de tratamento para pacientes com epilepsia refratária. A hemisferotomia pode produzir um controle notável da epilepsia hemisférica clinicamente intratável em crianças. O resultado final desejável, após a hemisferotomia, é o controle de crises e a redução ou retirada de fármacos antiepiléticos, visando a melhora cognitiva e do desenvolvimento da criança. Objetivos: verificar a efetividade da hemisferotomia no controle de crises e na retirada ou redução de fármacos antiepilépticos em pacientes classificados como Engel 1, e analisar os desfechos cognitivo e de desenvolvimento após a abordagem cirúrgica e redução de fármacos antiepilépticos. Métodos: revisão de prontuários médicos e banco de dados de pacientes crianças e adolescentes, com idade inferior a 19 anos no momento da cirurgia, submetidos a hemisferotomia para tratamento de epilepsia refratária no Centro de Epilepsia de Ribeirão Preto do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, entre anos de 1995 e 2015. Resultados: foram avaliados 120 prontuários médicos, dos quais foram considerados aptos 82. Amostra sem diferença significativa entre sexos. Para o manejo de fármacos foram considerados 44 pacientes que eram classificados como Engel 1 no segundo ano pós cirúrgico. Para estes pacientes foram avaliadas variáveis como retirada ou redução de fármacos antiepilépticos, bem como o tempo para que esse manejo fosse realizado, além do desfecho cognitivo e de desenvolvimento. Conclusão: A hemisferotomia é uma cirurgia eficaz para pacientes com doença hemisférica, possibilitando que paciente fique livre de crises e, eventualmente, livre de fármacos antiepilépticos. O desfecho de sucesso cirúrgico é dependente de inúmeras variáveis e o manejo de fármacos é realizado conforme experiência de profissionais de cada serviço. / Introduction: Epilepsy surgery is a treatment option for patients with refractory epilepsy. Hemisferotomy can produce a remarkable control of clinically intractable hemispheric epilepsy in children. The intended outcome, after hemispherotomy, is the seizure control and the reduction or withdrawal of antiepileptic drugs, aiming at the cognitive and developmental improvement of the child. Objectives: To verify the effectiveness of the hemispherotomy in the crisis control and in the withdrawal or reduction of antiepileptic drugs in patients classified as Engel 1, and to analyze the cognitive and developmental outcomes after the surgical approach and reduction of antiepileptic drugs. Methods: review of medical records and database of children and adolescents under 19 years of age at the time of surgery submitted to hemispherotomy for the treatment of refractory epilepsy at the Epilepsy Center of Ribeirão Preto, Hospital das Clínicas, Faculdade de Medicina of Ribeirão Preto between 1995 and 2015. Results: 120 medical records were evaluated, of which 82 were considered suitable. Sample with no significant difference between gender. For the management of drugs, 44 patients were classified as Engel 1 in the second postoperative year. For these patients, variables such as withdrawal or reduction of antiepileptic drugs were evaluated, as well as the time for this management to be performed, in addition to the cognitive and developmental outcome. Conclusion: Hemispherotomy is an effective surgery for patients with hemispheric disease, allowing patients to be seizure free and eventually free of antiepileptic drugs. The outcome of surgical success depends on innumerable variables and the management of drugs is performed according to the experience of professionals of each service.

Introdução: a cirurgia de epilepsia é uma opção de tratamento para pacientes com epilepsia refratária. A hemisferotomia pode produzir um controle notável da epilepsia hemisférica clinicamente intratável em crianças. O resultado final desejável, após a hemisferotomia, é o controle de crises e a redução ou retirada de fármacos antiepiléticos, visando a melhora cognitiva e do desenvolvimento da criança. Objetivos: verificar a efetividade da hemisferotomia no controle de crises e na retirada ou redução de fármacos antiepilépticos em pacientes classificados como Engel 1, e analisar os desfechos cognitivo e de desenvolvimento após a abordagem cirúrgica e redução de fármacos antiepilépticos. Métodos: revisão de prontuários médicos e banco de dados de pacientes crianças e adolescentes, com idade inferior a 19 anos no momento da cirurgia, submetidos a hemisferotomia para tratamento de epilepsia refratária no Centro de Epilepsia de Ribeirão Preto do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, entre anos de 1995 e 2015. Resultados: foram avaliados 120 prontuários médicos, dos quais foram considerados aptos 82. Amostra sem diferença significativa entre sexos. Para o manejo de fármacos foram considerados 44 pacientes que eram classificados como Engel 1 no segundo ano pós cirúrgico. Para estes pacientes foram avaliadas variáveis como retirada ou redução de fármacos antiepilépticos, bem como o tempo para que esse manejo fosse realizado, além do desfecho cognitivo e de desenvolvimento. Conclusão: A hemisferotomia é uma cirurgia eficaz para pacientes com doença hemisférica, possibilitando que paciente fique livre de crises e, eventualmente, livre de fármacos antiepilépticos. O desfecho de sucesso cirúrgico é dependente de inúmeras variáveis e o manejo de fármacos é realizado conforme experiência de profissionais de cada serviço. / Introduction: Epilepsy surgery is a treatment option for patients with refractory epilepsy. Hemisferotomy can produce a remarkable control of clinically intractable hemispheric epilepsy in children. The intended outcome, after hemispherotomy, is the seizure control and the reduction or withdrawal of antiepileptic drugs, aiming at the cognitive and developmental improvement of the child. Objectives: To verify the effectiveness of the hemispherotomy in the crisis control and in the withdrawal or reduction of antiepileptic drugs in patients classified as Engel 1, and to analyze the cognitive and developmental outcomes after the surgical approach and reduction of antiepileptic drugs. Methods: review of medical records and database of children and adolescents under 19 years of age at the time of surgery submitted to hemispherotomy for the treatment of refractory epilepsy at the Epilepsy Center of Ribeirão Preto, Hospital das Clínicas, Faculdade de Medicina of Ribeirão Preto between 1995 and 2015. Results: 120 medical records were evaluated, of which 82 were considered suitable. Sample with no significant difference between gender. For the management of drugs, 44 patients were classified as Engel 1 in the second postoperative year. For these patients, variables such as withdrawal or reduction of antiepileptic drugs were evaluated, as well as the time for this management to be performed, in addition to the cognitive and developmental outcome. Conclusion: Hemispherotomy is an effective surgery for patients with hemispheric disease, allowing patients to be seizure free and eventually free of antiepileptic drugs. The outcome of surgical success depends on innumerable variables and the management of drugs is performed according to the experience of professionals of each service.

Analysis of spontaneous adverse events reports of antiepileptic drugs Author: Ivana Šoborová Supervisor: PharmDr. Eva Zimčíková, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Epilepsy is one of the most common neurological diseases, which occurs worldwide. Antiepileptic drugs (AED) suppress the onset of an epileptic seizure. Analysis of spontaneous adverse drug reactions (ADRs) analysis is important data source for generating the potential risks signals in pharmacotherapy. Objective: The aim of this work was to analyse spontaneous reports of ADRs from the Czech Central Database of ADRs of the State Institute for Drug Control (SÚKL) in the period from June 2004 to October 2017. The analyses of potential drug interactions of all medicinal products mentioned in the reports and the assessment of the reported ADRs expectability was the secondary goal. Methods: Retrospective analyses of the spontaneous ADR reports of antiepileptic drugs obtained from the SÚKL in the given period. Anonymized data was processed using the descriptive statistics in MS Excel. For example, the patient characteristics or seriousness and expectability of the ADRs were evaluated. The specific adverse drug reactions were divided according to the system...

Les enfants diffèrent des adultes non seulement en termes de dimension corporelle mais aussi en termes physiologiques. En effet, les phénomènes de développement et maturation interviennent au cours de la croissance. Ces processus ne sont pas linéaires et induisent des différences pharmacocinétiques et pharmacodynamiques. Ainsi, contrairement à la pratique commune, il n’est pas approprié de déterminer les posologies pédiatriques directement à partir des doses adultes. Étudier la pharmacocinétique chez l’enfant est fondamental pour pouvoir déterminer les posologies à administrer. La méthodologie idéale est l’analyse de population à travers des modèles non-linéaires à effets mixtes. Cependant, même si cette méthode permet l’analyse de données éparses et déséquilibrées, le manque de données individuelles doit être compensé par l’inclusion de plus d’individus. Cela pose un problème lorsque l’indication du traitement est une maladie rare, comme le sont les syndromes épileptiques de l’enfance. Dans ce cas, l’extrapolation de modèles adultes à la population pédiatrique peut s’avérer avantageuse. L’objectif de ce travail de thèse était d’évaluer les recommandations posologiques d’antiépileptiques lorsque des données pharmacocinétiques pédiatriques sont suffisamment informatives pour permettre la construction d’un modèle, ou lorsque celles-ci ne sont pas suffisamment importantes ou ne peuvent pas être exploitées correctement. Dans un premier temps, un modèle parent-métabolite de l’oxcarbazépine et de son dérivé mono-hydroxylé (MHD) a été développé chez l’enfant épileptique âgé de 2 à 12 ans. Ce modèle a permis de mettre en évidence que les plus jeunes enfants nécessitent des doses plus élevées, ainsi que les patients co-traités avec des inducteurs enzymatiques. Un modèle a aussi été développé pour les enfants épileptiques de 1 à 18 ans traités avec la formulation de microsphères à libération prolongée d’acide valproïque. Ce modèle a tenu en compte le flip-flop associé à la formulation et la relation non-linéaire entre la clairance et la dose due à la liaison protéique saturable de façon mécanistique. Encore une fois, il a été mis en évidence le besoin de doses plus élevées pour les enfants plus jeunes. Puis, un modèle adulte du vigabatrin a été extrapolé à l’enfant pour déterminer les posologies permettant d’atteindre des expositions similaires à l’adulte pour traiter les épilepsies focales résistantes. A partir des résultats obtenus, qui sont en accord avec les conclusions d’essais cliniques, nous avons pu proposer une dose de maintenance idéale dans cette indication. Enfin, nous avons étudié la pertinence de l’extrapolation par allométrie théorique dans un contexte de non-linéarité avec l’exemple du stiripentol. Nous avons pu en conclure que cette méthode semble apporter de bonnes prédictions à partir de l’âge de 8 ans, contrairement aux molécules à élimination linéaire où cela semble correct à partir de 5 ans. En conclusion, nous avons pu tester et comparer différentes approches pour aider à la détermination de recommandations posologiques chez l’enfant. L’étude de la pharmacocinétique pédiatrique par des essais spécifiques reste indispensable au bon usage du médicament. / Children greatly differ from adults not only in terms of size but also in physiological terms. Indeed, developmental changes occur during growth due to maturation. These processes occur in a nonlinear fashion and can cause pharmacokinetic and pharmacodynamic differences. Thus, oppositely to common practice, it is not appropriate to scale pediatric doses directly and linearly from adults. The study of pharmacokinetics in children is then essential to determine those pediatric dosages. The more commonly used methodology is population analysis through non-linear mixed effects models. This method allows the analysis of sparse and unbalanced data. In return, the lack of individual data has to be balanced with the inclusion of more individuals. This can be a problem when the indication of treatment is a rare disease, as are epileptic syndromes of childhood. In this case, extrapolation of adult pharmacokinetic models to the pediatric population may be interesting. The objective of this thesis was to evaluate the dosage recommendations of antiepileptic drugs when pediatric pharmacokinetic data are sufficient to be modeled, and when they are not, extrapolating adequately adult information. Firstly, a parent-metabolite model of oxcarbazepine and its monohydroxy derivative (MHD) was developed in epileptic children aged 2 to 12 years. This model showed that younger children require higher doses, as well as patients co-treated with enzyme inducers. A model was also developed for epileptic children aged 1 to 18 years treated with a valproic acid sustained release microsphere formulation. This model took into account the flip-flop associated with the formulation and the non-linear relationship between clearance and dose caused by a saturable protein binding. Again, the need for higher doses for younger children was highlighted. Then, an adult model of vigabatrin was extrapolated to children to determine which doses allow to achieve exposures similar to adults in resistant focal onset seizures. From the results obtained, which are in agreement with the conclusions of clinical trials, we have been able to propose an ideal maintenance dose for this indication. Finally, we studied the relevance of extrapolation by theoretical allometry in a context of non-linearity with the example of stiripentol. We concluded that this method seems to provide good predictions from the age of 8, unlike the linear elimination molecules where it seems correct from 5 years. In conclusion, we were able to test and compare different approaches to help determine dosing recommendations in children. The study of pediatric pharmacokinetics in specific trials remains essential for the proper use of drugs.

Bakgrund: I Sverige förekommer epilepsi hos 1-2 % av alla hundar. De första anfallen visar sig oftast när hunden är mellan ett och sex år gammal. Det nuvarande förstahands­preparatet är fenobarbital, en substans som ökar tröskeln för elektrisk stimulering av motorcortex samt minskar monosynaptisk transmission som leder till minskad neuronal retbarhet. I februari 2013 registrerades ett nytt antiepileptikum med det verksamma äm­net imepitoin. Imepitoin är en partiell agonist som binder till bensodiazepinsätet på GABAA-receptorn. Det förstärker de GABAA-receptormedierade effekterna på neuro­nen samt har en svag kalciumblockerande verkan. Syfte: Arbetets syfte var att undersöka om imepitoin har förutsättningar att bli det nya förstahandspreparatet vid behandling av idiopatisk epilepsi. Vidare var syftet att under­söka i vilken utsträckning imepitoin fungerar som antiepileptikum samt vilken biverk­ningsprofil det har. Resultat: Behandling med imepitoin gav en sänkning av antalet epileptiska anfall per månad (MSF), liknande den som erhölls vid fenobarbitalbehandling. Imepitoin sänkte MSF både som monoterapi och i kombination med fenobarbital eller kaliumbromid. Biverkningsprofilen var överlag skonsammare för imepitoin jämfört med fenobarbital. Fenobarbital visade en leverpåverkan medan imepitoin påverkade kolesterolvärdet. Slutsats: Imepitoin har en antiepileptisk effekt, liknande den som fås vid behandling med fenobarbital. Behandling med imepitoin kan ske både som mono- samt kombina­tionsterapi. Den mildare biverkningsprofilen talar för användning av imepitoin. Samti­digt har fenobarbital använts under en längre tid så biverkningar vid långtids­användning är mer välkända än de vid imepitoinanvändning. / Background: In Sweden, approximately 1-2 % of all dogs suffer from epilepsy. The first seizures often occur when the dog is between one and six years old. In Sweden the first-line drug is phenobarbital, a substance which increases the threshold of electrical stimulation in the motor cortex. It also decreases synaptic transmission which leads to decreased neuronal excitability. In February 2013 a new antiepileptic drug was regis­tered with imepitoin as active substance. Imepitoin is a partial agonist which binds to the benzodiazepine binding site at the GABAA receptor and amplifies the effects medi­ated by GABAA receptors at the neurons. Additionally, imepitoin has a weak calcium channel blocking effect. Objective: The main aim of the study was to examine if imepitoin should be the first-line drug instead of phenobarbital when treating dogs diagnosed with idiopathic epi­lepsy. A further aim was to look into which effect imepitoin had in controlling the epilepsy and which adverse effects were experienced when dogs are treated with imepitoin. Results: Treatment with imepitoin resulted in a decrease in monthly seizure frequency (MSF), similar to the decrease seen upon treatment with phenobarbital. Imepitoin was decreasing MSF both when used as monotherapy and in combination with phenobarbital or potassium bromide. The adverse effects were in general less severe with imepitoin than with phenobarbital. Treatment with phenobarbital affected the liver while treatment with imepitoin affected the cholesterol levels. Conclusion: Imepitoin has a good antiepileptic effect, similar to that of phenobarbital. Treatment with imepitoin can be used both as monotherapy and in combination with other antiepileptic drugs. Less severe adverse effects makes imepitoin a possible choice for treating idiopathic epilepsy in dogs. On the other hand, phenobarbital has been used during a long period of time and adverse effects of long term use are therefore better known than for imepitoin.

The aim of this thesis was to describe the medical, cognitive and psychosocial consequences of epilepsy in young adulthood. Four studies were carried out with this patient group. The first two papers were based on a follow-up study regarding young adults with epilepsy that investigated medical and psychosocial aspects and compared the present results with those five years earlier. We then conducted focus group interviews with young adults with epilepsy and subjective cognitive decline to assess the deeper meaning of living with epilepsy accompanied by cognitive difficulties. In the fourth study we studied cognitive dysfunction further, choosing the language function in young adults with epilepsy. We firstly examined whether language impairments were associated to functional brain alterations and secondly related the language performance to demographics, clinical data, Quality of Life (QoL) and self-esteem. The five-year follow up of 97 young adults with uncomplicated epilepsy revealed no improvement regarding seizure frequency or side effects from anti-epileptic drugs (AEDs) over time, even though many new-generation AEDs had been established during this period. During the study period 21% had recovered from epilepsy, Seizure frequency among those who still had epilepsy had not improved, and 42% had experienced seizures during the past year. New-generation anti-epileptic drugs (AEDs) had been introduced to PWE, especially to women. There is still need for new and more effective treatment options for this group in the future. It is essential to find alternative approaches to develop better treatment options for this group in the future. However QoL was normal compared to the general population, indicating that new options regarding treatment can have made an impact. Lower QoL was correlated to high seizure frequency and to cognitive side effects. Self-esteem and Sence of Coherence were impaired compared to the situation at adolescence. Self-esteem was correlated to seizure frequency and to side-effects of antiepileptic drugs. Sence of Coherence was not correlated to epilepsy-related factors in the same way as QoL, but mirrored the phenomenon of epilepsy. The qualitative study showed that the consequences of epilepsy are not only restricted to the consequences of seizures, but also concerns many other aspects of life. The interviews revealed four themes: “affecting the whole person“, “influencing daily life”, ”affecting relations” and ”meeting ignorance in society”. Another important factor was language function; when one loses some language ability, this gives a feeling of losing one’s capability. The fourth study examined language by neuropsychological methods and correlated this function to brain activation measured by fMRI. Language functions measured in verbal fluency and abstract language comprehension were impaired in participants with both generalized epilepsy and epilepsy of focal onset. Age at onset of epilepsy and education are the most important factors correlating to language function. An additional factor that impacts abstract language comprehension is the frequency of convulsive seizures, while use of topiramate /zonisamide affect verbal fluency negatively. QoL was not correlated to language impairments, but for patients with focal onset seizures there was a correlation between self-esteem and abstract language comprehension. The fMRI investigation revealed altered activity during language tasks in participants with epilepsy compared to controls. In epilepsy with focal seizures originating in the left hemisphere, we found increased bilateral activation of supporting areas, in the anterior mid-cingulate cortex and the anterior ventral insulae, indicating a compensational functional reorganization. In generalized epilepsy, the functional language network showed an imbalance, as this group expressed an inadequate suppression of activation in the anterior temporal lobe during semantic processing. Subtle language impairment can, even if it does not occur in everyday dialogue, be of importance and have consequences for the person affected. The negative consequences of language decline must be addressed in people with epilepsy of different etiology. Young adults with epilepsy are still substantially affected by the condition. The consequences are not only restricted to the seizures, but concern many aspects of life and there is a great need for new treatment options for this group in the future.

L’épilepsie est l’une des pathologies neurologiques les plus fréquemment rencontrées dans le monde. Les indicateurs épidémiologiques sont élevés dans les pays en développement et le déficit thérapeutique y est important. Il n’existe pas d’études portant sur l’évaluation globale des barrières d’accès aux antiépileptiques (AE) dans ces pays. Pour développer et mettre en place un outil d’évaluation de ces barrières, nous avons réalisé quatre études : une revue systématique de la littérature sur les barrières potentielles d’accès aux traitements et aux soins de santé quel que soit la discipline médicale ; une enquête de terrain à Madagascar en vue d’établir les barrières spécifiques aux AE et déterminer la qualité de ces derniers ; une étude au Bénin afin d’y déterminer les barrières spécifiques à ce pays et une étude en Equateur basée sur le même outil d’évaluation que celui utilisé au Bénin. Afin de conforter notre méthode d’évaluation nous avons réalisé une enquête porte à porte en Equateur ainsi qu’une méthode de consensus Delphi sur nos principaux résultats. Nos travaux ont mis en évidence les principales barrières d’accès aux AE au Bénin qui sont le manque d’information des patients et des professionnels de santé sur la maladie et le manque de neurologues et de médecins formés à la prise en charge de l’épilepsie. A ces barrières également retrouvées en Equateur s’ajoutent les restrictions de prescription des médecins exerçant dans le public. Notre outil a démontré son intérêt pour l’évaluation des barrières d’accès aux antiépileptiques dans les pays en développement. / Epilepsy is one of the most common neurological diseases found in the world. Epidemiological indicators are higher in developing countries and the treatment gap is important. There are no study on the overall assessment of the barriers to accessibility of antiepileptic drugs (AEDs) in those countries. In order to develop an assessment tool of these barriers, we conducted four studies: a systematic review of the literature on potential barriers to access to treatment and health care regardless of the medical discipline; a field survey in Madagascar to establish specific barriers to AEDs and determine their quality; a study in Benin in order to determine the specific barriers in this country and a study in Ecuador based on the same evaluation tool used in Benin. To strengthen our method of evaluation we conducted a door-to-door survey in Ecuador and a Delphi consensus method on our main results. Our work has highlighted the main barriers to access of AEDs in Benin, which are lack of information for patients and healthcare professionals about the disease, and the lack of neurologists and physicians trained in the care of epilepsy. These barriers were also found in Ecuador, with, in addition, restrictions on prescription of doctors in the public hospitals. Our tool has demonstrated its interest in the evaluation of antiepileptic access barriers in developing countries.

Abstract Febrile seizures (FS) occur in 2-5% of children. Their pathogenesis is unknown. Elevated levels of prostaglandins (PG) have been found in cerebrospinal fluid after such seizures, and a third of all patients have recurrences. No safe ways of reducing the risk of recurrences have been found. The outcome has been shown in prospective studies to be good, by they have been linked to mesial temporal sclerosis (MTS) in patients with severe temporal lobe epilepsy (TLE). The aim was to analyze the records on the role of PGs in the pathogenesis of FS, to find risk factors for recurrences that are amenable to intervention and to evaluate the prevention of recurrences and the connection of FSs with MTS. We performed a systematic review of the effect of PGs and their synthetase inhibitors on seizures and a meta-analysis of the prevention of recurrences. The prophylactic effect of diazepam and acetaminophen on recurrences was evaluated in a placebo-controlled trial with 180 FS patients, and risk factors for recurrences were analysed from these data. To find MTS, MRI volumetry was performed after 12 years of follow-up on 64 cases chosen out of 329 unselected FS patients: twenty-four with a prolonged initial seizure, eight with a later unprovoked seizure and 32 age, sex and handedness-matched controls. PGD2, PGE1 and PGE2 had mainly anticonvulsive effects and PGF2alfa proconvulsive ones. NSAIDs had seizure-modulating effects in adult animals ranging from attenuation to provocation. Each degree of increase in fever doubled the recurrence risk, and each febrile episode increased it by 18%. The meta-analysis showed phenobarbital and valproate to prevent recurrences, but they cannot be recommended for FS as they have severe side-effects. The meta-analysis nullified the alleged effect of diazepam, and neither this nor acetaminophen prevented recurrences in a clinical trial. No MTS was found in any patient group. PGs may be involved in the pathogenesis of FS. No safe prophylaxis for recurrences is available, although the effect of antipyretics needs further evaluation. Measures to reduce feverish infections in order to prevent FS recurrences seem logical. MTS is uncommon even after prolonged FS.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24881号 / 医博第5015号 / 新制||医||1068(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 阪上 優 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introdução: A vigabatrina (VGB - Gama-Vinil-GABA) é um fármaco que eleva os níveis de GABA no organismo, por inibição irreversível da GABA transaminase, cuja eficácia foi bem demonstrada no controle dos espasmos epilépticos em lactentes, especialmente na síndrome de West secundária à esclerose tuberosa. Há escassez de estudos clínicos evidenciando um possível papel deste fármaco no controle de crises epilépticas neonatais e pouco se sabe sobre o potencial impacto do seu uso nessa faixa etária, seus possíveis efeitos adversos, ou se sua introdução teria associações positivas com controle mais adequado das crises na evolução e melhor desenvolvimento neuropsicomotor da criança. A VGB foi introduzida em nosso serviço como terapia de adição para o controle de crises neonatais refratárias, há vários anos, instigando nossa impressão sobre a eficácia deste medicamento no período neonatal. Objetivos: Avaliar a efetividade do uso da VGB como adjuvante no controle das crises eletrográficas e eletroclínicas do período neonatal e seus efeitos sobre o padrão do eletroencefalograma (EEG); Avaliar a evolução clínica e eletrográfica das crianças durante seguimento ambulatorial; Pesquisar associação entre \"controle de crises neonatais com introdução de VGB\" e diversas características demográficas, clínicas e evolutivas destes recém nascidos; Quantificar e caracterizar a ocorrência de efeitos adversos precoces e durante o seguimento. Pacientes e métodos: Estudo transversal retrospectivo, envolvendo o levantamento dos prontuários de uma amostra de recém-nascidos que receberam VGB como tratamento para crises neonatais refratárias aos fármacos convencionais e status epilepticus, no período de janeiro de 2007 a março de 2014, no Serviço de Neonatologia e Terapia Intensiva Neonatal do HCFMRP-USP, mantendo seguimento ambulatorial por pelo menos 1 ano. Foram avaliados os dados demográficos, etiologia e semiologia clínico-eletroencefalográfica das crises, esquema terapêutico prescrito, indicação da introdução da VGB, tempo de internação e tempo para atingir o controle das crises, evolução clínica e eletrencefalográfica durante a internação e no seguimento ambulatorial, época da suspensão da VGB, além de seus efeitos adversos. Resultados: De 48 recém-nascidos avaliados, 34 (79,2 %) obtiveram controle de crises eletrográficas e/ou clínicas durante o período neonatal, havendo melhora no padrão eletrográfico após a introdução da VGB em 79%. Quanto aos critérios para sua indicação, 33,3% (16 indivíduos) iniciaram VGB devido a falha terapêutica no controle das crises com fenobarbital e/ou fenitoína; 27,1% (13 recém nascidos), pela presença de estado de mal epilético e, em 12 crianças (25%), por falha terapêutica do midazolam. Ao final do primeiro ano de vida, a atividade de base do EEG mostrou-se desorganizada em 58,1% (18 de 29 pacientes que o realizaram aos 12 meses de vida). No seguimento ambulatorial de 38 pacientes, algum grau de atraso do desenvolvimento neuropsicomotor foi detectado em 20 crianças (52,6%); 19 lactentes (39,5%) mantiveram o uso da VGB em politerapia, tendo 22 crianças (57,9%) evoluído com persistência das crises epilépticas. Já 37,8% (14 pacientes) enquadraram-se em um padrão de encefalopatia epiléptica, que correspondeu à síndrome de West em 13,9% (5 de 36 crianças). Quanto ao EEG realizado em 34 crianças nessa fase, 17,6% (6 casos) demonstraram a presença de hipsarritmia, enquanto anormalidades focais ou multifocais foram detectadas em 50% (17 lactentes). A taxa de óbito ao final do primeiro ano foi de 23,3% (10 de 43 crianças analisadas quanto a este dado). Não foi possível comprovar déficit visual relacionado diretamente ao uso da VGB. A variável \"controle de crises no período neonatal com o uso da VGB\" foi associada aos seguintes desfechos clínicos favoráveis: melhora no padrão eletrográfico (92,1%), proporção menor de crianças evoluindo para síndrome de West e outras encefalopatias epilépticas (71,9% não tiveram tal desfecho); menor frequência de hipsarritmia no EEG (92,9% sem hipsarritmia), maior alcance de desenvolvimento neuropsicomotor normal (56,2% com bom desenvolvimento neurológico), menor índice de óbito neonatal (97,4% vivos nesta fase) e durante os primeiros doze meses de vida (87,9%). Conclusão: Acreditamos que a VGB seja uma opção terapêutica efetiva e com adequada relação custo-benefício, a ser implementada no controle de crises epilépticas neonatais refratárias como fármaco adjuvante aos convencionais. Entretanto, estudos randomizados e controlados são necessários para confirmar sua eficácia quando comparada a outros medicamentos disponíveis para uso nesta população, bem como para avaliar seus possíveis efeitos adversos a longo prazo. / Introduction: Vigabatrin (VGB - Gama-Vinil-GABA) is an antiepileptic drug which increases systemic GABA levels by irreversibly inhibiting GABA transaminase, with well demonstrated efficacy in the control of infantile epileptic spasms, specially related to West syndrome due to tuberous sclerosis. Clinical studies demonstrating a possible role of VGB in the control of neonatal seizures are still very scarce and very little is known on the impact of its use at this early age, as well as on its possible side effects or eventual positive associations from its use with more adequate seizure control or better neuropsychomotor development in the outcome. VGB has been used in our service as an add-on therapy for refractory neonatal seizures arising the impression that this could be an effective antiepileptic medication in the neonatal period. Objectives: To evaluate the use of VGB as an add-on medication regarding its effectiveness for the control of neonatal electrographic and electroclinical seizures, as well as its effects over the EEG pattern; To evaluate clinical and electrographic evolution of the children in follow-up; To estimate VGB efficacy on the control of neonatal seizures in relation to the demographical and clinical characteristics of those newborns; To quantify and characterize the occurrence of early and late side effects of this medication along follow-up. Patients and methods: This is a transverse retrospective study carried out through charts analysis from a sample of newborns who received VGB as add-on medication for seizures and/or status epilepticus refractory to conventional drugs, from January 2007 through March 2014, at the Neonatal Intensive Care Service of HCFMRP-USP, keeping follow-up in our institution for at least 1 year. Demographical and etiological data were analyzed, as well as clinical-electrographical semiology, VGB prescription indication, therapeutic schedule, time to reach seizure control, clinical and electrographical evolution while in hospital and at the follow-up, age at VGB withdrawal, besides adverse effects. Results: Among 48 newborns evaluated, 34 (79.2%) reached control of electrographic and/or clinical seizures during neonatal period, with improvement of the EEG pattern after VGB introduction in 79%. As for drug introduction criteria, 33.3% (16 children) were started on VGB due to therapeutic failure of phenobarbital and/or phenytoin; 27.1% (13 newborns), due to status epilepticus and, in 12 babies (25%), due to therapeutic failure of midazolam. By the end of the first year of life, EEG background activity was disorganized in 58.1% (18 out of 29 children who had EEG registered at 12 month of life). Along the one year follow-up of 38 patients, 20 infants (52.6%) showed some degree of neurodevelopmental delay; 19 children (39.5%) remained on VGB in polytherapy, with seizure persistence in 22 (57.9%). Evolution to an epileptic encephalopathy was found in 14 kids (37.8%), with West Syndrome being characterized in 13.9% (5 out of 36 kids). As for the EEG carried out in 34 children at the follow-up, 17.6% (6 cases) showed hypsarrhythmia while focal or multifocal abnormalities were seen in 50% (17 infants). Up to 12 month of life, the death rate was 23.3% (10 out of 43 children evaluated for such endpoint). Visual deficit directly related to VGB use could not be determined. The variable \"seizure control during the neonatal period after VGB use\" was associated to the following endpoints: improvement of the EEG pattern (92,1% of children with seizure control after VGB), lower proportion of children evolving into West syndrome and other epileptic encephalopathies (71.9% did not show such endpoint), lower frequency of hypsarrhythmia in the EEG (92.9% without hypsarrhythmia), better milestones reached regarding neuropsychomotor development (56.2% with good neurological outcome), lower rate of neonatal death (97.4% alive by the end of neonatal period) and along the first year of life (87.9%). Conclusion: VGB is an effective therapeutic option with adequate cost-benefit relationship which should be implemented for the control of refractory neonatal seizures as add-on therapy to conventional drugs. However, controlled randomized studies are necessary to confirm such efficacy as compared to other drugs available for use in the neonatal period, as well as to evaluate its possible long term side effects.