ABSTRACT
INTRODUCTION: Ivermectin, a 22'23 dihydro derivative of avermectins beta-1a, is a highly effective veterinary and human anti parasitic, used to treat endoparasites of difficult control such as filariasis and onchocerciasis, with a median plasma life of at least of 16 hours. The recommended therapeutic doses range from 0.05 to 0.40 mg/kg, without undesirable effects or risk to human life. It went from being a great success in animal health to its application in humans, where it has had great impact. Studies in basic sciences have shown that ivermectin has anticonvulsive effects in different epileptic animal models, where five different mechanisms of action have been described. PATIENTS AND METHODS: Descriptive, prospective observational study, performed between 2013 and 2015, with 32 refractory epileptic patients, who received ivermectin as an a dose of adjunctive treatment of 10 mg/day three or seven times a week, controlled every three months, followed by 12-24 months, without withdrawal of anticonvulsant medications that they received previously. RESULTS: Progressively, patients entered into crisis control, at the end of the programmed follow-up period, the total percentage of crisis reduction was 97%, of which 57% did not return to crisis from the beginning of treatment, all patients being free of crisis according to International League Against Epilepsy criteria. CONCLUSION: Ivermectin has been useful as an adjuvant, achieving a significant decrease in seizures in this group of drug resistant patients.
TITLE: Ivermectina como coadyuvante en la epilepsia refractaria.Introduccion. La ivermectina es un 22'23 dihidroderivado de las avermectinas beta-1a, un antiparasitario de uso veterinario y humano de gran eficacia, utilizado para tratar endoparasitos de dificil control, como la filariasis y la oncocercosis. Tiene una vida media plasmatica de al menos 16 horas. Las dosis terapeuticas recomendadas varian entre 0,05 y 0,40 mg/kg, sin efectos indeseados ni riesgo para la vida humana. Paso de ser un gran exito en sanidad animal a su aplicacion en seres humanos, donde ha tenido gran impacto. Estudios en ciencias basicas han demostrado que la ivermectina tiene efectos anticonvulsionantes en diferentes modelos animales epilepticos, donde se han descritos cinco diferentes mecanismos de accion. Pacientes y metodos. Estudio descriptivo, observacional prospectivo, realizado entre 2013 y 2015, con 32 pacientes epilepticos refractarios, quienes recibieron ivermectina como tratamiento coadyuvante en dosis de 10 mg/dia, tres o siete veces por semana, controlados cada tres meses, seguidos durante 12-24 meses, sin retirada de los medicamentos anticonvulsionantes que recibian previamente. Resultados. Progresivamente, los pacientes entraron en control de las crisis. Al final del periodo de seguimiento programado, el porcentaje total de reduccion de las crisis fue del 97%. El 57% de estos pacientes no volvio a presentar crisis desde el inicio del tratamiento, y todos los pacientes se encontraron libres de crisis segun los criterios de la Liga Internacional contra la Epilepsia. Conclusion. La ivermectina ha sido util como coadyuvante y ha logrado una significativa disminucion de crisis en este grupo de pacientes farmacorresistentes.
