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Pediatric Patients With Refractory Headache Respond to Zonisamide: Presented at IHS

By Claire Sowerbutt

KYOTO-JAPAN -- October 17, 2005 -- The antiepileptic agent zonisamide might provide clinicians with an efficacious alternative in the treatment of pediatric patients with refractory headache.

Used to treat pediatric epilepsy, the use of zonisamide has recently been reported as providing protection against headache in adolescents and adults. Consequently, Ann Pakalnis, MD, investigator, office of clinical sciences, Columbus Children's Research Institute, Ohio State University, Columbus, Ohio, and colleagues conducted a retrospective chart review of children treated with zonisamide for 12 months.

The study's results were presented as a poster here on October 10^th at the 12^th Congress of the International Headache Society (IHS).

In total, the researchers identified 7 girls and 4 boys with a mean age of 14.5 years who were seen at the Hospital's Pediatric Headache Clinic. Six children had diagnoses of episodic migraine, 3 had chronic migraine, and 2 had chronic daily headache mixed migraine versus tension headache.

Mean number of prior prophylactic headache medications used was 2.4 per patient; they included levetiracetam, celecoxib, topiramate, amitriptyline, propranolol, cyproheptadine, sertraline, imipramine, divalproex, and nadolol.

The researchers reviewed data on headache type using International Headache Society Criteria, headache frequency pre-and postzonisamide, duration of headache prior to study entry, zonisamide dosing, duration of treatment and follow-up, adverse events, previous headache prophylactic medications used and reasons for their discontinuation, concurrent medications and comorbid conditions or diagnoses, and basic demographics.

Response to treatment was defined as a decrease in headache frequency of at least 50%.

Responders and nonresponders had similar durations of headache prior to study entry (7 years and 6.1 years, respectively).

Results show that 7 of 11 children responded positively to zonisamide at an average dose of 5.2 mg/kg/day. The length of follow-up was between 3 and 12 months. Comorbid psychiatric conditions were present in 4 children; 3 responded well to zonisamide.

Adverse events led to discontinuation of zonisamide in 2 patients; 1 patient reported anorexia and the other experienced behavioral changes.


[Presentation title: A Retrospective Review of the Efficacy and Tolerability of Zonisamide in the Prophylaxis of Refractory Pediatric Headaches. Poster C031]

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