Treating refractory epilepsy with tiagabine: clinical experience.

Epilepsy remains difficult to treat with more than 30% of patients being refractory to conventional anticonvulsant therapy. Combination therapy may improve seizure control in some of these patients. Tiagabine is a new anticonvulsant that has a unique mechanism of action as a selective gamma-aminobutyric acid (GABA) re-uptake inhibitor (SGRI). Twenty consecutive patients with refractory epilepsy were treated with tiagabine, and prior to tiagabine administration the mean number of anticonvulsants that each patient had taken was five. Tiagabine therapy was initiated at a dose of 5 or 10mg per day and was increased at weekly increments of 5 or 10 mg per day, respectively. Thirty-five percent of patients receiving tiagabine (20-40 mg per day, mean 34.29 mg per day) achieved a > or =50% reduction in seizure frequency. Tiagabine was effective when added to carbamazepine, lamotrigine, or oxcarbazepine. Tiagabine appeared more effective at higher doses. Side effects were predominately central nervous system-related, the most common being dizziness. For optimal results, tiagabine should be initiated at low doses and titrated slowly. This observational study has demonstrated tiagabine to be effective and safe in patients with refractory epilepsy.