Contributions
Abstract: EP1821
Type: ePoster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: Dalfampridine-ER (DAL) is a broad-spectrum voltage-gated potassium channels blocker, that is indicated in multiple sclerosis (MS) to improve nerve conduction in demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of seizures.
Objective: 3 case-reports about MS patients (Pts) with «de novo» convulsive status epilepticus (CSE) probably related to DAL administration.
Methods: 3 Pts with secondary progressive MS (2 women (Pt1:26 years,Pt2:60 years) and a man (Pt3:48 years), were admitted because of CSE. Their medical charts recorded:mean age at MS diagnosis: 22 years-old, last average EDSS 7 with spastic paraparesis, no history of seizures or renal impairment.
Pt 1:She observed a treatment with DAL, 10 mg tid, introduced 3 years ago, with baclofen and tamsulosine. She presented a tonic clonic seizure. Intravenous (IV) diazepam was given, but myoclonus of left hemiface persisted. IV phenytoin then IV phenobarbital was given because of persistant EEG focal temporal SE.
Pt 2 :Treatment with DAL was introduced 4 years ago, with oxybutinin, baclofen and qizenday ATU. She presented continuous myoclonic jerks involving the right side of the body with impaired awareness. IV diazepam then IV phenytoin then IV levetiracetam were indicated because of persistant EEG focal ictal activity.
Pt 3:DAL was introduced 2 days ago, with baclofen. He presented with five tonic-clonic seizures in between impaired consciousness persisted. IV diazepam led to the resolution of CSE.
Biological tests were normal. Brain MRI showed diffuse cortical and subcortical atrophy, without active inflammatory lesion.
Results: All 3 Pts presented with CSE that were attributed to DAL, which was discontinued. All Pts were on baclofen at admission, which was tapered down. Anti-epileptic drug was introduced: phenytoin and eslicarbazepine (Pt1), levetiracetam and phenytoin (Pt2). Third Pt presented 9 months after a new tonic-clonic seizure, and levetiracetam was introduced. No DAL compliance deviations were identified.
Conclusion: These case-reports illustrate that «de novo» CSE is a potential complication of MS patients treated with DAL. All Pts had important cortical and subcortical demyelination on brain MRI, but no renal impairment that would have enabled lowered renal excretion of DAL. All Pt had concomitant therapy with baclofen, a proepileptic drug. Potential interaction between these 2 drugs may have precipitated CSE in our Pts.
Disclosure:
CLF has participated to scientific boards for Biogen, Roche, Novartis, Merck, medDay. Others authors disclosed no affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias.
Abstract: EP1821
Type: ePoster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: Dalfampridine-ER (DAL) is a broad-spectrum voltage-gated potassium channels blocker, that is indicated in multiple sclerosis (MS) to improve nerve conduction in demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of seizures.
Objective: 3 case-reports about MS patients (Pts) with «de novo» convulsive status epilepticus (CSE) probably related to DAL administration.
Methods: 3 Pts with secondary progressive MS (2 women (Pt1:26 years,Pt2:60 years) and a man (Pt3:48 years), were admitted because of CSE. Their medical charts recorded:mean age at MS diagnosis: 22 years-old, last average EDSS 7 with spastic paraparesis, no history of seizures or renal impairment.
Pt 1:She observed a treatment with DAL, 10 mg tid, introduced 3 years ago, with baclofen and tamsulosine. She presented a tonic clonic seizure. Intravenous (IV) diazepam was given, but myoclonus of left hemiface persisted. IV phenytoin then IV phenobarbital was given because of persistant EEG focal temporal SE.
Pt 2 :Treatment with DAL was introduced 4 years ago, with oxybutinin, baclofen and qizenday ATU. She presented continuous myoclonic jerks involving the right side of the body with impaired awareness. IV diazepam then IV phenytoin then IV levetiracetam were indicated because of persistant EEG focal ictal activity.
Pt 3:DAL was introduced 2 days ago, with baclofen. He presented with five tonic-clonic seizures in between impaired consciousness persisted. IV diazepam led to the resolution of CSE.
Biological tests were normal. Brain MRI showed diffuse cortical and subcortical atrophy, without active inflammatory lesion.
Results: All 3 Pts presented with CSE that were attributed to DAL, which was discontinued. All Pts were on baclofen at admission, which was tapered down. Anti-epileptic drug was introduced: phenytoin and eslicarbazepine (Pt1), levetiracetam and phenytoin (Pt2). Third Pt presented 9 months after a new tonic-clonic seizure, and levetiracetam was introduced. No DAL compliance deviations were identified.
Conclusion: These case-reports illustrate that «de novo» CSE is a potential complication of MS patients treated with DAL. All Pts had important cortical and subcortical demyelination on brain MRI, but no renal impairment that would have enabled lowered renal excretion of DAL. All Pt had concomitant therapy with baclofen, a proepileptic drug. Potential interaction between these 2 drugs may have precipitated CSE in our Pts.
Disclosure:
CLF has participated to scientific boards for Biogen, Roche, Novartis, Merck, medDay. Others authors disclosed no affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias.