Journal of child neurology
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In this report, we examine the interrelationships between attention deficit disorder (ADD), learning disabilities (LD), and conduct and oppositional disorders (COD). We indicate that it is reasonable to consider ADD as a distinct entity, frequently co-occurring with LD on the one hand, and COD on the other. ⋯ In the next section, we review the evidence linking ADD with COD, a distinction blurred in earlier investigations by problems with referral bias. More recent studies suggest that the antecedents, clinical characteristics, and prognosis may differ in children with ADD alone compared to those with ADD in association with COD.
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Vigabatrin is an enzyme-activated, irreversible inhibitor of gamma-aminobutyric acid (GABA) aminotransferase, which causes a marked increase in cerebral GABA concentration and a resulting anticonvulsant action. Recovery from its effects requires the synthesis of new enzyme, and this may take several days following a single dose. The pharmacokinetics of vigabatrin are not a good guide to its duration of action. ⋯ Also, vigabatrin does not induce liver enzymes, as do many of the standard antiepileptic drugs. In several trials, however, a small but significant reduction in phenytoin levels has been seen following the addition of vigabatrin to the antiepileptic medication. The mechanism for this reduction in phenytoin levels has not yet been elucidated, though it does not appear to be of clinical significance.
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Vigabatrin has been studied in adult drug-resistant epilepsy since 1982 in single-blind and double-blind studies followed by long-term, open evaluations. These studies have provided evidence that vigabatrin is a potent and well-tolerated antiepileptic drug and support its potential value in pediatric epilepsy. The lack of any evidence of human neurotoxicity in these patients is also reassuring regarding its use in children.
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The antiepileptic effect of vigabatrin in adults has been demonstrated in a number of controlled studies. In children, the effect of vigabatrin has been investigated only to a limited extent. In order to assess the long-term effect and safety of vigabatrin in patients with severe epilepsy, an open, add-on, dose-ranging study was initiated. ⋯ However, when seizures recurred, they did so at much lower frequency than recorded at the start of the study. Thirteen patients (39%) reported adverse events attributable to vigabatrin; one was immediately withdrawn from the study, and six had their vigabatrin dose reduced. No physiologic effects were noted on normal growth or clinical physical examination.