Portal de Periódicos da CAPES

Letters to the Editor: 1

2002; Wiley; Volume: 43; Issue: 2 Linguagem: Inglês

10.1046/j.1528-1157.2002.casa432.x

1528-1167

Paul Casaer, Marc Boel,

Neuroscience and Neuropharmacology Research

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.