Porphyria is a group of disorders of heme biosynthesis that may be subcategorized as hepatic and erythropoietic. Seizures (and other neurologic problems) occur only in the hepatic group. Acute intermittent porphyria, porphyria cutanea tarda, hereditrary coproporphyria, and variegate porphyria may be associated with seizures. Seizures occur in 15% of cases of patients, may be precipitated by AEDs, and begin up to 28 days after drug exposure. Most AEDs are problematic because of their porphyrogenic potential, which has been demonstrated both in vitro and in vivo. Bromides have long been used more safely than most AEDs, though tolerability issues have given rise to more use of newer AEDs without significant hepatic metabolism, such as gabapentin 1 and, theorectically, levetiracetam, though lists of drugs that exacerbate porphyria are available 2.
- Gabapentin treatment of seizures in acute intermittent porphyria. Neurology. (1995); vol. 45 (iss. 6): p. 1216-1217. ;
- Drug treatment in acute porphyria. Br J Clin Pharmacol. (1997); vol. 44 : p. 427-434.
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