Gabapentin can significantly improve dystonia severity and quality of life in children. (January 2016)

• Record Type: Journal Article
• Authors: Liow, Natasha Yuan-Kim; Gimeno, Hortensia; Lumsden, Daniel Edward; Marianczak, Jennifer; Kaminska, Margaret; Tomlin, Stephen; Lin, Jean-Pierre Sao-Ming
• Is Part Of: European journal of paediatric neurology. Volume 20:Number 1(2016:Jan.)
• Page Start: 100
• Page End: 107
• Publication Date: 2016-01
• Subjects: Dystonia -- Gabapentin -- Cerebral palsy -- NBIA -- WHO International Classification of function -- Dystonia severity Assement Plan -- Children; GMFCS Gross Motor Function Classification System -- DSAP Dystonia Severity Assessment Plan -- ICF-CY WHO International Classification of Functioning -- Disability and Health Children & Youth -- ELCH Evelina London Children's Hospital -- GABA gamma-aminobutyric acid -- ADL activities of daily living -- DBS deep brain stimulation -- ITB intrathecal baclofen; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2015.09.007
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: Introduction: Gabapentin has been used in the management of neuropathic pain, epilepsy and occasionally movement disorders. Methods: A four-year retrospective, observational study analysed the use of gabapentin for severe dystonia in children at the Evelina London Children's Hospital. Motor severity was classified according to the Gross Motor Function Classification System (GMFCS), Dystonia Severity Assessment Plan (DSAP) and levels of impairment in activities of daily living were graded according to the WHO International Classification of Functioning, Disability and Health, Children & Youth version (ICF-CY) before and after gabapentin. Results: The majority of the 69 children reported were level 5 GMFCS (non-ambulant). The DSAP grade fell significantly from grade 3 before to grade 1 after gabapentin. Significant improvements in median ICF-CY grades were seen following gabapentin in sleep quality, sleep amount, mood & agreeableness, pain, general muscle tone, involuntary muscle contractions and seating tolerance ( p < 0.01 in all areas). A significantly higher mean dose of 18.1 mg/kg/dose (SD: 13.3) for dystonia, compared to 7.61 mg/kg/dose (SD: 4.14) for pain relief without dystonia ( z = −2.54, p = 0.011) was noted. Discussion & conclusion: Gabapentin may significantly ameliorate dystonia severity and improve activities of daily living and quality of life in children with severe dystonia. Highlights: Dystonia is often severe and unremitting in most children, despite conventional medication such as triheyphenidyl, baclofen, benzodiazepines and levodopa, irrespective of aetiology Gabapentin improved sitting and night-time sleep evaluated by the Dystonia Severity Action Plan (DSAP) and improved activity and participation measured with the WHO International Classification of Functioning, Disability and Health, Children & Youth version (ICF-CY). Gabapentin was well-tolerated. A significantly higher mean dose of 18.1 mg/kg/dose (SD: 13.3) for dystonia, compared to 7.61 mg/kg/dose (SD: 4.14) for pain relief without dystonia ( z = −2.54, p = 0.011) was required.