Millett D, Pach S. Fenfluramine in the successful treatment of super-refractory status epilepticus in a patient with Dravet syndrome.
Epilepsy Behav Rep 2021;
16:100461. [PMID:
34179745 DOI:
10.1016/j.ebr.2021.100461]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
Dravet syndrome (DS) patient in super-refractory status epilepticus (SRSE) for 5 weeks.
Add-on fenfluramine (FFA) successfully treated SRSE in DS.
Most effective dose of FFA was 0.7 mg/kg/day.
Long-term FFA provided >90% reduction in seizures and prevented status epilepticus.
FFA maintenance also resulted in improvement of neurocognitive function.
A 20-year-old woman with Dravet syndrome and multiple prior episodes of status epilepticus presented to our hospital in November 2018 in super-refractory status epilepticus. After 5 weeks of unsuccessful continuous treatment with anesthetics, including pentobarbital and ketamine, we sought and were granted an emergency approval by the United States Food and Drug Administration to administer fenfluramine, an investigational new drug, to this patient. One week of treatment with fenfluramine at 0.4 mg/kg/day was ineffective. The dose of fenfluramine was titrated to 0.7 mg/kg/day, and after 1 week, electrographic seizures ceased. One week later, the patient was seizure-free and off all anesthetic agents. Add-on treatment with fenfluramine was continued with no further episodes of status epilepticus and >90% reduction in tonic-clonic seizures. This case report illustrates the potential for fenfluramine to prevent reoccurrence of status epilepticus and to manage super-refractory status epilepticus in patients with Dravet syndrome.
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