Adjunctive Madopar for ultrarefractory epilepsy? Preliminary observations
The optimum drug treatment for ultrarefractory epilepsy after failure of seven prior antiepileptic drugs (AEDs) remains uncertain. Prompted by reports that adjunctive amantadine or l-dopa has been useful for children with refractory absence seizures and Lennox-Gastaut syndrome, we studied the utility of dopaminergic agents for adults with ultrarefractory epilepsy. We assessed seizure control following adjunctive treatment for up to 12 months with the dopaminergic agent Madopar© in three adult patients with ultrarefractory epilepsy following brain injury or with Lennox-Gastaut syndrome, who had not achieved sustained seizure remission during past treatment with at least seven lifetime AEDs. The adjunctive use of Madopar was associated with a reduction or remission of tonic-clonic seizures in two patients. However, Madopar seemed to have aggravated absence seizures in the patient with Lennox-Gastaut syndrome. Although our preliminary observations do not and cannot establish the efficacy or safety of adjunctive Madopar, it may be an option for treatment of ultrarefractory focal seizures in adults if confirmed by randomized controlled trials.