Resolution of epileptic encephalopathy following treatment with transdermal nicotine

Authors

  • Ayelet Zerem,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
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  • Daniella Nishri,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
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  • Yael Yosef,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
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  • Lubuv Blumkin,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
    3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Dorit Lev,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
    3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    4. Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
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  • Esther Leshinsky-Silver,

    1. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
    2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    3. Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
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  • Sara Kivity,

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
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  • Tally Lerman-Sagie

    1. Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
    2. Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
    3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    4. Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
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Address correspondence to Tally Lerman-Sagie, Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel. E-mail: asagie@post.tau.ac.il, tally.sagie@gmail.com

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.

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