Dados do Trabalho

Título

Successful treatment with Cannabidiol in a patient with Infantile Spasms and Tuberous Sclerosis

Apresentação do caso

Case presentation: A 7-year-old child diagnosed with Tuberous Sclerosis presented with focal motor seizures and infantile spasms, starting at three months of age. He has been treated with the following drugs in the first year of life without seizure control: vigabatrin, prednisone, valproate, phenobarbital, lamotrigine, oxcarbazepine and topiramate. At 12 months of age, Cannabidiol (CBD) was associated with vigabatrin and levetiracetam regimen, achieving complete seizures control and allowing satisfactory neuropsychomotor development. At 16 months of age, he achieved four months seizure-free, and he was crawling, undergoing speech therapy, occupational therapy and physical therapy. At age 2, he walked without support and spoke his first words. At three years and five months, he could form sentences and was without seizures. He could already recognize colours and geometric figures at the age of four. At five years of age, clinical and motor development improvement was evident. At age 6, he recognized the entire alphabet and wrote his name. Cranial magnetic resonance imaging (MRI) was performed at two years of age and showed cortical tubers or subependymal nodules. An electroencephalogram (EEG) was performed at eight months of age, indicating hypsarrhythmia. EEG after using Cannabidiol showed marked improvement.

Discussão

Discussion: Patients with Tuberous Sclerosis are more likely to develop West Syndrome. 0ur patient was refractory to the treatment of Infantile Spasms with conventional drugs, So we chose to use CBD as an addiction therapy. As a result, the patient evolved with significant improvement in seizure control, neuropsychomotor development and EEG. The satisfactory evolution of the patient´s neuropsychomotor and cognitive development was documented by filming on the follow-up and electroencephalographic recordings before and after the introduction of CBD.

Comentários finais

Final comments: CBD has recently been approved as an add-on therapy for Tuberous Sclerosis associated seizures. However, it is not yet known which type of seizures have a better response, which is the best combination in polytherapy regimen and which moment in the epilepsy algorithm treatment to introduce this drug. In this case report presented with Tuberous Sclerosis and refractory infantile spasms, the use of CBD was essential for the seizures control and a good prognosis concerning the patient's cognitive and motor development.