Neurologist private practice Greenwich, Connecticut
Rationale: Lorcaserin was approved by the U.S. Food and Drug Administration in 2012 for the treatment of obesity. In 2018 Tolette et al. showed that the drug was helpful in the treatment of severe childhood onset epilepsy suggesting that it might be helpful in the treatment of medically refractory seizures in other types of epilepsy. (Lorcaserin therapy for severe childhood epilepsy of childhood onset: a case series. Tolette et al. Neurology 2018; 91; 837-839.) Methods: The records of all patients in an outpatient practice treated with lorcaserin in the past two years until the drug was withdrawn from the market February 13, 2020 were reviewed. Results: There were 16 patients: eight women, eight men with ages ranging from 32 to 76 who took lorcaserin for three to 18 months. Most used a dose of 20 mg twice a day. Four had Lennox Gastaux syndrome; in three of these convulsive seizures were reduced by 100-75% until access to the drug was lost. In a fourth drop attacks were reduced by 80%. Three of the four patients with Lennox-Gastaut syndrome showed a noticeable improvement in cognition and an increased ability to interact with family members. A patient with juvenile myoclonic epilepsy who could not tolerate valproate stopped having episodes of myoclonic status that had been occurring every two weeks. The remaining ten patients had a variety of focal epilepsies. Two stopped the drug due to side effects and the seizures of two others were not helped. The remaining seven had their focal seizures reduced by 90-100%. Those whose supply of drug ran out at the time of this writing all had exacerbation of their seizures. Conclusions: This is a retrospective uncontrolled series and some patients were followed for only three months such that a honeymoon effect could easily have been missed. Nevertheless, lorcaserin appeared to be a useful adjunctive seizure medication in a variety of epilepsies suggesting that drugs with related mechanisms of action such as fenfluramine might be considered for more than just severe childhood epilepsy. Funding: Please list any funding that was received in support of this abstract.: no funding
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