© 2005 BMJ Publishing Group & Royal College of Paediatrics and Child Health
PERSPECTIVE
Epilepsy
Pyridoxine or pyridoxal phosphate for intractable seizures?
Correspondence to:
Correspondence to:
Dr P Baxter
Consultant Paediatric Neurologist, Sheffield Children’s Hospital, Western Bank, Sheffield S10 5DD, UK; p.s.baxter@sheffield.ac.uk
Commentary on the paper by Wang et al (see page 512)
Keywords: pyridoxine; pyridoxal phosphate; seizures; epilepsy
| The first 150 words of the full text of this article appear below. |
The short answer is pyridoxal phosphate, but before reaching for the prescription pad it’s worth looking at the context. Intractable seizures have no set definition.1 One practical approach is to review management when seizures continue despite the use of two appropriate anticonvulsants at maximum tolerated doses. Points to consider include whether the diagnosis is correct, as syncope and other non-epileptic events can still mislead; the cause of the seizures, for example structural, chromosomal, neurodegenerative, or metabolic conditions; whether there is an avoidable precipitant; whether the choice of drug and dose were correct, as for example carbamazepine can exacerbate some primary generalised epilepsies; and compliance.1 Treatment options include other anticonvulsants; drugs such as vitamins, acetazolamide, or steroids; IVIG; specific diets; resective and other types of surgery, the vagal nerve stimulator, and a variety of other approaches such as yoga, epilepsy dogs, etc.
Pyridoxine dependency is a rare but well described
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- Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy
- H-S Wang, M-F Kuo, M-L Chou, P-C Hung, K-L Lin, M-Y Hsieh, and M-Y Chang
Arch. Dis. Child. 2005 90: 512-515.[Abstract] [Full Text] [PDF]
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