Infantile spasms and the
Lennox-Gastaut syndrome are considered to be age-specific pediatric
epileptic syndromes and together constitute a significant percentage of medically resistant
seizures in childhood. Twenty children, ages 4 to 28 months (median, 12 months), with medically refractory
infantile spasms or the
Lennox-Gastaut syndrome, were treated with the investigational
benzodiazepine nitrazepam in an open-label study. Daily dosage of
nitrazepam ranged from 0.5 to 3.5 mg/kg, with a median dosage of 1.5 mg/kg, divided into two doses per day. Side effects included pooling of oral secretions (12 children) and sedation (six children); however, no serious side effects were seen. Responses to
nitrazepam were as follows: five complete responses (cessation of all
seizures), seven partial responses (greater than 50% reduction of
seizures), and eight with no response. Median duration of response was 9 months (range, 4 to 16 months) in children with
infantile spasms and 14 months (range, 8 to 26 months) in children with the
Lennox-Gastaut syndrome.
Nitrazepam is an effective
anticonvulsant in this small cohort of children with medically refractory
infantile spasms and the
Lennox-Gastaut syndrome, resulting in a 25% response rate and only modest side effects.