Abstracts

RATIONALE: Ledderhose's syndrome (LS) or plantar fibromatosis is a rarely reported and possibly underdiagnosed adverse drug reaction (ADR) to barbiturates. LS may occur alone or in combination with Dupuytren's contracture or other connective tissue disorders. As long as an etiological relationship is not suspected and AED treatment is not discontinued or switched to another drug, patients are at risk of repeated surgical interventions. METHODS: Clinical observation with report on two LS-patients with multiple operations before necessary changes of the AED regimen. RESULTS: The first patient was a 31 years-old man with cryptogenic epilepsy with focal and secondarily generalized seizures since the age of eight. He was treated with different AEDs but was put on a combination of phenobarbitone (PB) and valproate (VPA) at the age of 26. In the following years he had four operations of his feet due to recurrent plantar fibrosis. The second patient was a 39 years-old woman with most probably symptomatic epilepsy due to perinatal vascular brain damage. She was initially treated with VPA which was combined with PB due to continuing seizures since the age of 23. Between 1996 and 1999 she experienced four LS-operations. Histopathologic evaluations of surgical specimen were performed and PB was removed from AED treatment in both patients. CONCLUSIONS: Clinicians should be more aware of LS as a possible ADR of phenobarbital and other barbiturate-AEDs. Early consideration of alternative treatments is mandatory to avoid multiple surgical interventions.