KCNT1-positive epilepsy of infancy with migrating focal seizures successfully treated with nonnarcotic antitussive drugs after treatment failure with quinidine: A case report.
Journalbrain & development1.504Date
2020 Jun 03
4 months ago
Case Report
2020-Sep / 42 : 607-611
Takase C 1, Shirai K 2, Matsumura Y 1, Watanabe T 1, Watanabe A 1, Hirasawa-Inoue A 3, Mizuguchi T 4, Matsumoto N 5, Sugai K 3, Hayashi M 6
  • 2. Department of Pediatrics, Tsuchiura Kyodo General Hospital, Ibaraki, Japan. Electronic address: [email protected]
  • 3. Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
  • 4. Department of Neurosurgery, National Center of Neurology and Psychiatry, Tokyo, Japan.
  • 5. Department of Human Genetics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
  • 6. College of Nursing and Nutrition, Shukutoku University, Tokyo, Japan.
BACKGROUND: Epilepsy of infancy with migrating focal seizures (EIMFS) is one of the early-onset epileptic encephalopathies resistant to antiepileptic drugs, therefore carrying an extremely poor neurodevelopmental outcome. KCNT1, encoding for a sodium-activated potassium channel (KCa4.1 channel), has recently been reported as the major gene responsible for EIMFS. Since gain of function is the only type of mutation identified in patients with EIMFS, quinidine, a partial antagonist of KCa4.1 channel, is considered as a potential candidate for targeted treatment of EIMFS. However, treatment results reported so far vary from seizure-free state to no response, and cardiac side effect remains a challenge for dose titration and long-term treatment.
CASE REPORT: Our case was an infant diagnosed with EIMFS with confirmed mutation in KCNT1 gene. Quinidine therapy was started as early as 9 months old. Within the first month of treatment, the number of seizures reduced to about one third. However, seizure-free state was not obtained and his neuropsychological development remained severely delayed. After 16 months of treatment, quinidine had to be discontinued because of cardiac side effects. At 27 months of age, however, his seizures suddenly stopped and he remained seizure-free for five days. This coincided with the prescription of tipepidine, a commonly used antitussive, administered for his persistent cough. Reduction in seizure frequency was also observed with dextromethorphan, another conventional antitussive drug. Although the relation between these treatments and his symptom improvement is a matter of elucidation, there is a possibility that these nonnarcotic antitussive drugs might play a role in the treatment of EIFMS.
Keywords: Epilepsy of infancy with migrating focal seizures KCNT1 Nonnarcotic antitussive drugs Quinidine
Brain Devbrain & development

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