Successful Treatment of Seizures and Porphyria With Gabapentin

Abstract

Most anticonvulsants can precipitate clinically latent porphyria by inducing hepatic metabolism and increasing hepatic heme synthesis [1-3]. Due to this interaction, seizures in patients with hepatic porphyria and epilepsy are frequently undertreated with benzodiazepines or low doses of other anticonvulsants [4,5]. Gabapentin, a new anticonvulsant for treating partial seizure disorders, is renally excreted without metabolism, does not induce hepatic oxidation, [6] and is therefore a potential therapy for treating partial seizures in patients who also have hepatic forms of porphyria. We report successful treatment of complex partial seizures using gabapentin in a patient with porphyria cutanea tarda symptoms while taking other anticonvulsants. Case report. The patient is a 60-year-old African-American woman with a history of hypertension and chronic alcohol use (one to two six-packs of beer per weekend). In 1992, she had new-onset seizures, experiencing four complex partial and secondary generalized seizures over an 8-month period. Neurologic examination and routine EEG were normal. MRI demonstrated a probable small cortical infarction in the right parietal area, with an area of …