Linda Azevedo Kauppila, I. Amorim, C. Bentes, A. Peralta
{"title":"Trazodone: A New Antiepileptic Drug for Dravet Syndrome?","authors":"Linda Azevedo Kauppila, I. Amorim, C. Bentes, A. Peralta","doi":"10.1055/s-0039-1677783","DOIUrl":null,"url":null,"abstract":"Abstract Dravet syndrome (DS) is associated with severely refractory seizures. Recent studies suggest possible antiepileptic effects of serotonergic drugs. We report the case of a 25-year-old woman with DS-related epilepsy (SCN1A mutation), with daily seizures since childhood, associated with developmental delay. Several antiepileptic drug regimens were tested, without clear benefit. Over the years, she maintained a pattern of diurnal and nocturnal seizures, with a nocturnal predominance averaging two tonic–clonic seizures per night, with periods of seizure clusters. On routine electroencephalography (EEG), frequent, subtle myoclonic seizures during sleep were detected. A seizure-free period or significant reduction in seizure frequency was never attained. Trazodone was started due to insomnia. This led to a remarkable as well as long-standing clinical and neurophysiological improvement: less than one reported tonic–clonic seizure per month during the next 18 months, reduction in interictal epileptiform activity (170/h vs. 30/h of sleep), myoclonic seizures (90/h vs. 0.7/h of sleep), and tonic–clonic seizures (2/night to 0) on video-EEG. Serotonergic pathway modulation effects on DS-related epilepsy were observed in animal studies, in addition to small case series using lorcaserin and fenfluramine. To the best of our knowledge, no clinical data exist showing that trazodone may be an efficacious agent in patients with DS. Despite limitation of an isolated case with possible chance factors, our data, given the striking effect, provide this clinical evidence for the first time, and may have important clinical implications in patients with DS, reinforcing the need for further research on this subject.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1677783","citationCount":"7","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Epilepsy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0039-1677783","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 7
Abstract
Abstract Dravet syndrome (DS) is associated with severely refractory seizures. Recent studies suggest possible antiepileptic effects of serotonergic drugs. We report the case of a 25-year-old woman with DS-related epilepsy (SCN1A mutation), with daily seizures since childhood, associated with developmental delay. Several antiepileptic drug regimens were tested, without clear benefit. Over the years, she maintained a pattern of diurnal and nocturnal seizures, with a nocturnal predominance averaging two tonic–clonic seizures per night, with periods of seizure clusters. On routine electroencephalography (EEG), frequent, subtle myoclonic seizures during sleep were detected. A seizure-free period or significant reduction in seizure frequency was never attained. Trazodone was started due to insomnia. This led to a remarkable as well as long-standing clinical and neurophysiological improvement: less than one reported tonic–clonic seizure per month during the next 18 months, reduction in interictal epileptiform activity (170/h vs. 30/h of sleep), myoclonic seizures (90/h vs. 0.7/h of sleep), and tonic–clonic seizures (2/night to 0) on video-EEG. Serotonergic pathway modulation effects on DS-related epilepsy were observed in animal studies, in addition to small case series using lorcaserin and fenfluramine. To the best of our knowledge, no clinical data exist showing that trazodone may be an efficacious agent in patients with DS. Despite limitation of an isolated case with possible chance factors, our data, given the striking effect, provide this clinical evidence for the first time, and may have important clinical implications in patients with DS, reinforcing the need for further research on this subject.
摘要Dravet综合征(DS)与严重难治性癫痫发作有关。最近的研究表明,5-羟色胺能药物可能具有抗癫痫作用。我们报告了一例患有DS相关癫痫(SCN1A突变)的25岁女性,自儿童时期起每天癫痫发作,与发育迟缓有关。测试了几种抗癫痫药物方案,但没有明确的益处。多年来,她一直保持着日间和夜间发作的模式,夜间发作占主导地位,平均每晚两次强直-阵挛发作,发作周期为集群。在常规脑电图(EEG)上,可以检测到睡眠期间频繁、细微的肌阵挛发作。从未达到无癫痫发作期或癫痫发作频率的显著降低。曲唑酮是由于失眠而开始服用的。这导致了一个显著且长期的临床和神经生理学改善:在接下来的18个月里,每月不到一次报告的强直-阵挛性发作,发作间期癫痫样活动减少(170/h vs.30/h睡眠),肌阵挛发作(90/h vs.0.7/h睡眠),以及视频脑电图上的强直-发作(2/night to 0)。除了使用lorcaserin和fenfluramine的小病例系列外,还在动物研究中观察到5-羟色胺能通路对DS相关癫痫的调节作用。据我们所知,目前还没有临床数据表明曲唑酮可能是治疗DS患者的有效药物。尽管可能的偶然因素限制了一个孤立的病例,但考虑到显著的效果,我们的数据首次提供了这一临床证据,并可能对DS患者具有重要的临床意义,加强了对这一主题进行进一步研究的必要性。