Abstracts

RATIONALE: Despite the development of new antiepileptic agents, the therapy of epilepsies along with hepatic porphyrias remains difficult. Most anticonvulsants such as carbamazepine, phenytoin, valproinate and lamotrigin can precipitate clinically latent porphyria by inducing hepatic metabolism and increasing hepatic heme synthesis. Actually, only gabapentin - presenting an anticonvulsant without any hepatic metabolism - is known as a potential therapy for treating partial seizures in patients having hepatic forms of porphyria. METHODS:_ We present the case of a 28 year-old-male with hepatic porphyria who has suffered from a pharmacoresistent kryptogen focal epilepsy with complex partial and secondary generalized seizures since early childhood. In spite of having undergone several antiepileptic drug therapies through the years, no seizure free interval had been observed at all. Only carbamazepine could cause a seizure reduction, but had to be discontinued as an elevation of the transaminases was noted. The patient was then started on oxcarbazepine, a ketoanalogue of carbamazepine similar in its pharmacological mechanism as well as its clinical usage, but in contrast to carbamazepine only has a low hepatic induction of microsomal enzymes, with a final maintenance dose of 4 times more than carbamazepine RESULTS: In the follow up the patient became seizure free and the liver function was normal. CONCLUSIONS: : It can be concluded that oxcarbazepine can be tried in patients with porphyria and focal epilepsy who have not been successfully treated with gabapentin.