Abstract
We report the case of a 50-year-old male patient with idiopathic generalised epilepsy and porphyria cutanea tarda. Valproic acid and phenobarbital monotherapy controlled seizures but exacerbated porphyric symptomatology, while clobazam, clonazepam and lamotrigine monotherapy were well tolerated as regards porphyric disturbances but did not completely control seizures. Tonic-clonic seizures were eventually controlled by a combination of clonazepam (9 mg/ day) and lamotrigine (150 mg/day), but absences persisted and this treatment caused significant adverse effects consisting of sedation and memory disturbances. Levetiracetam monotherapy (3 g/day) was accompanied by complete control of seizures; memory disturbances and sedation also resolved, and no porphyrinogenetic activity of levetiracetam was observed. This is the first report of the safe use of levetiracetam in porphyria cutanea tarda.
Similar content being viewed by others
References
Shedlofsky SI, Sinclair PR, Bonkovsky HL, et al. Haem synthesis from exogenous 5-aminolaevulinate in cultured chick-embryo hepatocytes: effects of inducers of cytochromes P-450. Biochem J 1987; 248: 229–36
Krauss GL, Simmons-O’Brien E, Campbell M. Successful treatment of seizures and porphyria with gabapentin. Neurology 1995; 45: 594–5
Bonkowsky HL, Sinclair PR, Emery S, et al. Seizure management in acute hepatic porphyria: risks of valproate and clonazepam. Neurology 1980; 30(6): 588–92
Reynolds Jr NC, Miska RM. Safety of anticonvulsants in hepatic porphyrias. Neurology 1981; 31: 480–4
McGuire GM, Macphee GJ, Thompson GG, et al. Effects of sodium valproate on haem biosynthesis in man: implications for seizure management in the porphyric patient. Eur J Clin Invest 1988; 18: 29–32
Jalil P, Vergara F. Porphyria induced by valproic acid: clinical case. Rev Med Chil 1991; 119: 920–1
Hahn M, Gildemeister OS, Krauss GL, et al. Effects of new anticonvulsant medications on porphyrin synthesis in cultured live cells: potential implications for patients with acute porphyria. Neurology 1997; 49(1): 97–106
Paul F, Meencke HJ. Levetiracetam in focal epilepsy and hepatic porphyria: a case report. Epilepsia 2004; 45: 559–60
Zaatreh MM. Levetiracetam in porphyric status epilepticus: a case report. Clin Neuropharmacol 2005; 28(5): 243–4
D’Alessandro R, Rocchi E, Cristina E, et al. Safety of valproate in porphyria cutanea tarda. Epilepsia 1988; 29(2): 159–62
Larson AW, Wasserstrom WR, Felsher BF, et al. Posttraumatic epilepsy and acute intermittent porphyria: effects of phenytoin, carbamazepine, and clonazepam. Neurology 1978; 28: 824–8
Thadani H, Deacon A, Peters T. Diagnosis and management of porphyria. BMJ 2000; 320: 1647–51
Acknowledgements
No sources of funding were used to assist in the preparation of this report, and the authors have no conflicts of interest that are directly relevant to the contents of this report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bilo, L., Meo, R. & de de Leva, M.F. Levetiracetam in Idiopathic Generalised Epilepsy and Porphyria Cutanea Tarda. Clin. Drug Investig. 26, 357–359 (2006). https://doi.org/10.2165/00044011-200626060-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00044011-200626060-00007