Seizure management in acute hepatic porphyria

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Abstract
Seizures may occur in acute intermittent porphyria or other hepatic porphyrias. Management is difficult, because barbiturates and hydantoins exacerbate the porphyric state. One patient with major motor seizures and acute intermittent porphyria was studied. The seizure disorder was exacerbated by phenytoin and did not respond to a high-carbohydrate diet or to i.v. hematin. Clonazepam was ineffective in treating the seizures and, in high doses, seemed to exacerbate the porphyria. Clonazepam and valproate were porphyrinogenic in experimental test systems. Because both drugs may exacerbate the acute hepatic porphyrias, bromide remains the drug of choice to treat these seizures.

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