Dexfenfluramine effective in drug-resistant temporal lobe epilepsy

Dexfenfluramine, the therapeutically active dextro-rotatory stereoisomer of fenfluramine, is a serotonin (5-hydroxytryptamine [5-HT]) agonist. The drug, as well as its active metabolite dexnorfenfluramine, stimulate synaptic serotonin release, inhibit presynaptic serotonin reuptake, and stimulate postsynaptic serotonin receptors directly. Because serotonin circuits are involved in appetite control, both fenfluramine and dexfenfluramine have been widely used as anorexic agents in the treatment of obesity. However, several experimental data indicate that serotonin systems also suppress neuronal network excitability and are, therefore, related to epilepsy.1 We report a patient in whom drug-resistant seizures and food intake disorders were effectively controlled by dexfenfluramine.