Etemadifar Masoud, Saboori Masih, Chitsaz Ahmad, Nouri Hosein, Salari Mehri, Khorvash Reza, Sheibani Tehrani Donya, Aghababaee Ali
Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
Mult Scler Relat Disord. 2020 Aug;43:102188. doi: 10.1016/j.msard.2020.102188. Epub 2020 May 22.
Fampridine was first approved by the US Food and Drug Administration (FDA) to improve walking in multiple sclerosis (MS) patients, which was demonstrated by an increase in their walking speed. Nevertheless, the medication has been reported to possess an epileptogenic effect since it blocks the voltage-gated potassium channels in neural fibers. Several studies have indicated that the risk of seizure among fampridine consumers is not substantially higher than that in the general MS population, however. The objective of this study is to describe 97 MS patients for whom fampridine was prescribed and to assess the incidence of post-medication seizures.
This cohort study included 97 MS patients with gait problems who referred to the Isfahan Clinic of MS from August 2017 to September 2019. The exclusion criteria were a previous or family history of seizure or a history of renal impairment. Fampridine was prescribed for all the patients at a dose of 10 mg twice daily (12 hours apart).
three patients (with an approximate incidence rate of 0.015 per 100 patient-years) presented with generalized tonic-clonic seizures, 7, 9, and 14 months after initiating fampridine consumption. The radiological findings revealed significant cortical and subcortical lesions in the three patients. Further, two of them consumed baclofen or fingolimod simultaneously with fampridine.
The reported incidence rate is relatively higher than that in the general MS population. The extensive (sub) cortical lesions and the concomitant medications probably have an important role in the epileptogenesis, regardless of fampridine. However, the potential pro-convulsant properties of fampridine should not be overlooked.
氨吡啶最初由美国食品药品监督管理局（FDA）批准用于改善多发性硬化症（MS）患者的行走能力，这通过其步行速度的提高得到了证实。然而，据报道该药物具有致癫痫作用，因为它会阻断神经纤维中的电压门控钾通道。不过，多项研究表明，服用氨吡啶的患者癫痫发作风险并不比一般MS人群显著更高。本研究的目的是描述97例开具了氨吡啶处方的MS患者，并评估用药后癫痫发作的发生率。
这项队列研究纳入了97例有步态问题的MS患者，这些患者于2017年8月至2019年9月转诊至伊斯法罕MS诊所。排除标准为既往有癫痫发作史或家族史，或有肾功能损害史。所有患者均开具了氨吡啶，剂量为每日两次，每次10毫克（间隔12小时）。
3例患者（每100患者年的发生率约为0.015）在开始服用氨吡啶后7、9和14个月出现全身强直阵挛性发作。影像学检查结果显示，这3例患者均有明显的皮质和皮质下病变。此外，其中2例患者在服用氨吡啶的同时还服用了巴氯芬或芬戈莫德。
报告的发生率相对高于一般MS人群。广泛的（皮质）下病变和同时服用的药物可能在癫痫发生中起重要作用，无论是否与氨吡啶有关。然而，氨吡啶潜在的促惊厥特性不应被忽视。
