Resolution of epileptic encephalopathy following treatment with transdermal nicotine

• Published in: Epilepsia (Copenhagen) Vol. 54; no. 1; pp. e13 - e15
• Main Authors: Zerem, Ayelet, Nishri, Daniella, Yosef, Yael, Blumkin, Lubuv, Lev, Dorit, Leshinsky‐Silver, Esther, Kivity, Sara, Lerman‐Sagie, Tally
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2013; Wiley Subscription Services, Inc
• Subjects: Adolescence; Adolescent; Age; Autosomal dominant nocturnal frontal lobe epilepsy; Brain; Cognitive ability; EEG; Electroencephalography; Encephalopathy; Epilepsy; Epilepsy, Frontal Lobe - drug therapy; Epilepsy, Frontal Lobe - physiopathology; Etiology; Female; Frontal lobe; Humans; Mutation; Nicotine; Nicotine - administration & dosage; Nicotine - therapeutic use; Nicotinic acetylcholine receptors; Refractory epilepsy; Seizures; speech; Tobacco Use Cessation Products; Transdermal medication; Treatment Outcome
• ISSN: 0013-9580; 1528-1167; 1528-1167
• DOI: 10.1111/j.1528-1167.2012.03715.x

Summary 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.