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NEUROLOGY 1978;28:824
© 1978 American Academy of Neurology

Posttraumatic epilepsy and acute intermittent porphyria

Effects of phenytoin, carbamazepine, and clonazepam

Alan W. Larson, M.D., William R. Wasserstrom, M.D., Bertram F. Felsher, M.D. and Joyce C. Shih, M.S.

Departments of Medicine and Neurology, Veterans Administration Hospital, Long Beach, California, and the University of California, Irvine, School of Medicine, Irvine, California.

A patient with uncontrolled posttraumatic epilepsy and acute intermittent prophyria was subjected to successive therapeutic trials with phenytoin, carbamazepine, and clonazepam, while eating an adequate diet. Both phenytoin and carbamazepine treatments caused significant increases in porphobilinogen excretion and appeared to induce acute porphyric attacks. In contrast, treatment with clonazepam under rigid dietary control for 10 days caused no increase in porphobilinogen excretion. During the subsequent 7 months of treatment with clonazepam, neither seizures nor porphyric attacks recurred. These findings suggest that clonazepam may be a safe and effective treatment for chronic or severe generalized seizure disorders in patients with acute intermittent porphyria.

Reprint requests should be addressed to Dr. Felsher, Hepatology Section, Veterans Administration Hospital, 5901 E. 7th Street, Long Beach, CA 90822.

This investigation was supported in part by the Medical Research Programs of the Veterans Administration.

Accepted for publication December 28, 1977.






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