82 Epilepsy Res., 6 (1990) 82-84 Elsevier EPIRES 00333 Short Communication Nifedipine as an add-on drug in the management of refractory epilepsy J.W.A.S. Sander and P.C. Trevisol-Bittencourt INSEG - Epilepsy Research Group, Institute of Neurology, Queen Square, London, WC1N 3BG (U. K.), and National Hospital, Chalfont Centrefor Epilepsy, Chalfont St. Peter, Gerrards Cross, Bucks. SL9 ORI (U.K.) (Received 3 January 1990; accepted 13 February 1990) Key words: Nifedipine; Refractory epilepsy; Calcium blockers We report the effects of the addition of nifedipine, a calcium channel antagonist, to the antiepileptic therapy of 20 patients with se- vere medically refractc.'7 epilepsy. Six patients developed side effects and in two the drug had to be discontinued because of these. The commonest side effects were headaches, dizziness and lethargy. Two patients experienced deterioration in seizure control and only 2 patients showed improved seizure control. One of these patients subsequently developed tolerance at 5 months. In 16 patients there was no change. INTRODUCTION Theoretical considerations suggest that blockers of calcium channels may have anticonvulsant ac- tivity, and this has been confirmed in experimental seizure models3"5. Fiunarizine and nifedipine, two calcium channel antagonists, have been reported as useful drugs in the management of patients with intractable epilepsyL2. The present paper describes a pilot study in which the effectiveness of nifedipine as an antiepi- ieptic drug in the management of patients with se- vere medically refractory epilepsy in a tertiary referral centre was investigated. PATIENTS AND METHODS Twenty adult patients with a mean age of 31 years were studied. All patients were evaluated as in-patients at the National Hospital, Chalfont Correspondence to: Dr. J.W.A.S. Sander, National Hospi- tal, Chalfont Centre for Epilepsy, Chalfont St. Peter, Gerrards Cross, Bucks. SL9 0RJ, U.K. Centre for Epilepsy. All patients gave informed consent and specific criteria for entry into the study included: 4 or more seizure events/month in the immediate pre-trial period; an adequate pre- vious trial of treatment with carbamazepine (CBZ), phenytoin (PHT), phenobarbitone (PB) or primidone (PRM) and sodium valproate (SVP) in monotherapy or combination; no active psychi- atric or systemic condition; no pseudo-seizures complicating epilepsy. Table I shows the clinical details of the patients. Nine patients had cryptogenic epilepsy and the re- maining 11 patients had symptomatic epilepsy. Five patients were on monotherapy (3 on CBZ and 2 on PHT), 10 patients were taking 2 AEDs and 5 were taking 3 AEDs. Concomitant drugs in- cluded CBZ, PHT, FB, PRM, SVP and clobazam. Nifedipine slo~-release was used in an open fashion as an add-on drug. It was added to the treatment regimen starting with 10 mg twice/day. The daily dose was gradually increased, in weekly steps, to a maximum dose of 80 mg/day, provided no side effects occurred. The concomitant AED treatment was not changed throughout the study 0920-1211190/$03.50© 1._990 Elsevier Science Publishers B.V. (Biomedical Division)