Reactions 1474, p18 - 19 Oct 2013

SDonepezil/fampridine

Generalised tonic-clonic seizures: case reportA 50-year-old woman experienced generalised tonic-clonic

seizures while receiving fampridine [dalfampridine] anddonepezil.

The woman had a history of secondary progressive multiplesclerosis. She began receiving fampridine 10mg twice daily toimprove her ambulation, and donepezil 5mg daily for herworsening cognition [routes not stated]. Four days later, 1 hourafter her eighth dose of fampridine, her husband found herhaving a generalised tonic-clonic seizure. She subsequentlyexperienced a second seizure, and she was hospitalised. MRIfound atrophy, small-vessel ischaemic disease and symmetricventriculomegaly, with no evidence of recent infarct orenhancing mass, while EEG showed "no frank epileptiformactivity".

Fampridine was withdrawn, and the woman was transferredto an inpatient rehabilitation unit. At last follow-up, there hadbeen no recurrence of seizure activity.

Author comment: "[Donepezil] may have lowered thepatient’s threshold to seizure activity because this was startedat the same time as the dalfampridine. Because the patientdid not have any further seizure activity in the 2 yrs since shewas taken off dalfampridine, it is likely that the short durationin which she received the medication was the primaryetiology of her seizure activity."Farag A, et al. Dalfampridine: is the seizure risk greater than previously thought?.American Journal of Physical Medicine and Rehabilitation 92: 635-636, No. 7, Jul2013. Available from: URL: http://dx.doi.org/10.1097/PHM.0b013e31826ed8ea -USA 803094444

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Reactions 19 Oct 2013 No. 14740114-9954/13/1474-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved