Calcium-channel blocker verapamil administration in prolonged and refractory status epilepticus.
We report on an 11-year healthy boy who presented refractory status epilepticus (SE), which was unresponsive to conventional antiepileptic drugs used in the algorithm of the treatment of SE. Based on evidence that verapamil has anticonvulsant activity in animal models and the fact that the boy had a supraventricular tachycardia (140-160 b/min), i.v. verapamil (0.034 mg/min) was administered on day 37, and after a 3.125 mg cumulative verapamil dose (1.5 hour after initiation of the infusion), the patient regained consciousness was able to breathe spontaneously and the electrical SE promptly disappeared. The apparent dramatic response to i.v. verapamil may be explained by its direct anticonvulsant action on the basis of the potential involvement of calcium channels in epileptic activity and that verapamil, a known Pgp inhibitor in the cerebrovascular endothelium in the epilepticus focus, acted by facilitating the brain penetration of the antiepileptic drugs that our patient was receiving simultaneously.
Iannetti
Paola
P
Division of Child Neurology, Department of Paediatrics, University La Sapienza 2, Rome, Italy. paola.iannetti@uniroma1.it
Spalice
Alberto
A
Parisi
Pasquale
P
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000037:antagonists & inhibitors / Q000378:metabolism; D000208:Acute Disease; D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000378:metabolism; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome; D014700:Verapamil / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000927:Anticonvulsants; D002121:Calcium Channel Blockers; D014700:Verapamil