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Cited by 27Epilepsy research and treatmentPharmacological Effects and Toxicity StudiesDiet and metabolism studies

Letters to the Editor: 1

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Casaer, Paul, Boel, Marc·2002·Epilepsia
DOI 10.1046/j.1528-1157.2002.casa432.x
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Abstract

To the Editor: We read the article by Gentsch et al. (1) describing the influence of fenfluramine and paroxetine on the epileptic activity of rat entorhinal cortex with great interest. After the publication of Aicardi and Gastaut (2), we used fenfluramine in a group of 11 children with intractable epilepsy resistant to other anti-epileptic drugs available at that time (3). We now report our further experience with fenfluramine in 22 patients. All patients had severe tonic–clonic seizures before the add-on therapy. Since 1988, fenfluramine has been used as add-on therapy in patients with self-induced seizures (22 of 22). Most of the patients were photosensitive at the time of the diagnosis (13 of 22). So far, 22 patients (11 girls, 11 boys) have been treated (Table 1). In six patients (group A), fenfluramine did not improve seizure control, and the drug was discontinued. Ten patients (group B) continued to use fenfluramine because of a 90% improvement rate. Only sporadic, minor ocular seizures still occur. Six patients (group C) continued to use fenfluramine because seizures were completely controlled. In groups B and C, side effects were limited to transient loss of appetite (one of 16 children) and fatigue after work or physical exercise (one of 16 patients). One of the six patients with complete seizure control (group C), who was taking sodium-valproate and fenfluramine, was seizure free for 10 years. EEGs did not reveal any epileptiform activity at age 24 years. Stopping fenfluramine resulted in a generalized tonic–clonic seizure, during which she broke a leg. Restarting fenfluramine, again resulted in complete seizure control. Apart of this single seizure, the six patients (in group C) had seizure-free periods ranging from 1 to 12 years. In 16 patients (group B and C) still taking fenfluramine, the duration of add-on therapy varied between 1 and 12 years, and the dose of fenfluramine varied between 0.25 and 1 mg/kg/day. We conclude that in young patients with intractable epilepsy and self-induced seizures, fenfluramine should be considered as add-on therapy.

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Research works printed but not linked: 5

  1. Schmitz D, Gloveli T, Empson RM, et al. Serotonin reduces syn- aptic excitation in the superficial medial entorhinal cortex of the rat via a presynaptic mechanism. J Physiol (Lond) 1998;508:119-29.
  2. Wada JA, Balzamo R, Meldrum BS, et al. Behavioral and electro- graphic effects of L-5-hydroxytryptophan and D,L-parachloro- phenyl-L-alanine on the baboon, Papio papio. Electroencephalogr Clin Neurophysiol 1972;33:520-6. REFERENCES
  3. Ross J, Kearse LA, Barlow MK, et al. Alfentanil-induced epilep- tiform activity: a simultaneous surface and depth electroencepha- lographic study in complex partial epilepsy. Epilepsia 2001;42: 220-5.
  4. Tempelhoff R, Modica PA, Bernardo KL, et al. Fentanyl-induced electrocorticographic seizures in patients with partial epilepsy. J Neurosurg 1992;77:201-8.
  5. Manninen PH, Burke SJ, Wennberg RA, et al. Intraoperative lo- calization of an epileptogenic focus with alfentanil and fentanyl. Anesth Analg 1999;88:1110-6.

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Authors
Casaer, P., & Boel, M.
Affiliations
KU Leuven (BE)
Venue
Epilepsia
Publisher
Wiley
Published
2002-02
Volume
43
Issue
2
Pages
205-206
ISSN
  • 0013-9580 (ISSN-L)
  • 1528-1167
DOI
10.1046/j.1528-1157.2002.casa432.x
OpenAlex
W2040634726
Cited by
27
References
4
Citations by year
2024: 2 · 2023: 1 · 2022: 1 · 2021: 4 · 2019: 1 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 7
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 46 d)
Locations
  • Epilepsia (publishedVersion)
  • PubMed (publishedVersion)
Funders
University of Toronto
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
Keywords
fenfluramine, drug-resistant epilepsy, self-induced seizures, photosensitive epilepsy, adjunctive therapy, tonic-clonic seizures, seizure control, children, paroxetine, entorhinal cortex
MeSH terms
Anticonvulsants, Fenfluramine, Humans

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