Resolution of epileptic encephalopathy following treatment with transdermal nicotine.
We report resolution of an epileptic encephalopathy by administration of transdermal nicotine patches in an adolescent with severe nonlesional refractory frontal lobe epilepsy. The 18.5-year-old female patient had refractory epilepsy from the age of 11. Recurrent electroencephalography (EEG) recordings showed mostly generalized activity, albeit with right frontal predominance. Almost all antiepileptic medications failed to provide benefit. She developed an encephalopathic state with cognitive decline. The nonlesional frontal lobe epilepsy and a family history of a cousin with nocturnal epilepsy with frontal origin suggested genetic etiology. Transdermal nicotine patches brought complete resolution of the seizures, normalization of the EEG, and a significant improvement in her thinking process and speech organization. Sequencing of the CHRNB2 and CHRNA4 genes did not detect a mutation. Transdermal nicotine patches should be considered in severe pharmacoresistant frontal lobe epilepsy.
Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
Ayelet
A
Zerem
Daniella
D
Nishri
Yael
Y
Yosef
Lubuv
L
Blumkin
Dorit
D
Lev
Esther
E
Leshinsky-Silver
Sara
S
Kivity
Tally
T
Lerman-Sagie
D000293:Adolescent; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use*; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome
D009538:Nicotine