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Dexfenfluramine, the therapeutically active dextro-rotatory stereoisomer of fenfluramine, is a serotonin (5-hydroxytryptamine [5-HT]) agonist. The drug, as well as its active metabolite dexnorfenfluramine, stimulate synaptic serotonin release, inhibit presynaptic serotonin reuptake, and stimulate postsynaptic serotonin receptors directly. Because serotonin circuits are involved in appetite control, both fenfluramine and dexfenfluramine have been widely used as anorexic agents in the treatment of obesity. However, several experimental data indicate that serotonin systems also suppress neuronal network excitability and are, therefore, related to epilepsy.1 We report a patient in whom drug-resistant seizures and food intake disorders were effectively controlled by dexfenfluramine.
Case report.
A 15-year-old girl had clonic movements at 2 months of age involving both her upper limbs alternatively. At 6 months, febrile and afebrile hemiclonic seizures occurred, involving the right side of her body with subsequent generalization. At age 8 months her weight was 8.1 kg (50th percentile) and her length was 68 cm (50th percentile). Her motor development was normal. The child experienced complex partial seizures (CPS) characterized by motor arrest followed by oroalimentary automatism with or without secondary generalization. Sometimes CPS ended with a yell. An EEG showed left temporal–central and diffuse paroxysmal activity. Valproic acid and phenobarbital were administered without …
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