Pharmacological synthesis – Flavia Cantone
First hospitalization- June 2009: hypotonic and mioclonic crisis
DEPAKIN without effect
RIVOTRIL
After a month in adding with ZARONTIN: excellent effect for one year and two months.
Second hospitalization- September 2010: she starts also to be absent
We tried, together with rivotril and zarotin,
FRISIUM without effect
KEPPRA no effect
LAMICTAL no effect
We tried again with DEPAKIN no effect
ACTH caused her blood pressure to rise
TOPOMAX good effect for 7 months. She is not absent any more
Third hospitalization- June 2011
HYDROCORTISONE good effect after a month but it also caused her blood pressure to rise after one month an a half.
Fourth hospitalization– August 2011: while reducing HYDROCORTISONE increases mioclonic crisis; she was absent just once with strong mioclonies
Continuing with RIVOTRIL and ZARONTIN plus:
again with TOPOMAX, effect just for one week
again with FRISIUM and reduction of rivotril but immediately inserted again because stronger crises started
She is unable to swallow and she uses a drip for nutrition.
introduction of NOOTROPIL: good initial result
At home:
LUMINALE very good effect but just for one month
VIMPAT with a slow increment and relative reduction of LUMINALE – worsening
Fifth hospitalization- October 2011
Continuing with ritrovil and zarontin plus:
VIMPATwith dosage but without effect
Introduced DINTOINA but the mioclonies have increased
Introducted INOVELON with little effect ( episodes of vomiting started, it’s not sure if they had been caused by the inovelon, because she often vomits with drips)
With only rivotril and zarontin she stabilizes for not more than ten days
Tried KEPPRA again plus ZONEGRAN reducing ZARONTIN
Discharged in November 2011 with:
RIVOTRIL, KEPPRA AND ZONEGRAN for four months. She is always conscious, she has got a lot of mioclonies above all in the upper limbs, she can
no longer sit down, her voluntary abilities are very limited but she can eat and drink in small amounts and she is starting to speak again with short sentences.
We tried to substitute KEPPRA with ZARONTIN, because it had such a good effect in the past, but it was unsuccessful.
Shehas started to loose her weight, so we have reduced and thenstoppedthetherapywith zonegran.
In the month of July we tried ACTH, until the half of August (it has been incremented slowly because of the pressure situation), with small effect but the pressure didn’t rise.
We tried with hydrocortisone again but it caused her blood pressure to rise;reducing itmiocloniesstarted again so she has been hospitalized again.
Sixth hospitalizationSeptember2012
EvenMIDAZOLAM has an immediate effect but during the hospitalization the effect diminishes and URBASON is added for three days.
Mioclonies continue even if they are weaker, but suspending MIDAZOLAM they start to be stronger so it’s necessary to reintegrate Midazolam again.
During the hospitalization the effect diminushes and URBASON is added for three days followed by a tablet of 10mgDELTACORTENE.
Mioclonies continue even if they are weaker, but suspending midazolam they start to be stronger and they oblige to reintegrate midazolam again.
In the long run the effect is weaker and weaker.
We are trying again with TOPOMAX also with a higher quantity(6 mg/kg).