Autonomic Epilepsy: Clonidine Blockade of Paroxysmal Catecholamine Release and Flushing

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Abstract
A 59 yr old man was studied with transient paroxysms of hypertension, tachycardia and flushing in whom pheochromocytoma was excluded. Although catecholamine excretion was normal, plasma catecholamine levels rose from normal basal levels (282 .+-. 14 pg/ml) to increased levels (585 .+-. 67 pg/ml;) at the peak of spells. Other hormones or substrates expected to rise with nonspecific stress did not increase after paroxysms. Therapy with clonidine (0.2-0.4 mg/day) suppressed basal catecholamines to undetectable levels and markedly reduced peak levels during spells (80 pg/ml). An epileptic pathogenesis was suggested by stereotypic olfactory and epigastric prodromata before spells, and abolition of paroxysms with the anticonvulsant carbamazepine. This patient represented a rare case of autonomic epilepsy with the seizure focus in the temporal lobe.