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Psychiatr Prax 2010; 37(3): 148-151
DOI: 10.1055/s-0029-1223464
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© Georg Thieme Verlag KG Stuttgart · New York

Off-label-Behandlung eines Patienten mit rezidivierender familiärer hemiplegischer Migräne und begleitenden vorübergehenden psychotischen Episoden

Off-Label Use of Acetazolamide in a Patient with Familial Hemiplegic Migraine and Concomitant Psychotic EpisodesHorst  J.  Koch1 , André  Sykora2 , Patrick  Hausn1 , 2
  • 1Klinik für Psychiatrie und Psychotherapie, HELIOS Klinikum Aue
  • 2Klinik für Neurologie, HELIOS Klinikum Aue
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Publication History

Publication Date:
10 February 2010 (online)

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Zusammenfassung

Ein 42-jähriger, aufgrund einer Meningitis im Vorschulalter intelligenzgeminderter Patient, leidet seit Jahren an rezidivierenden Hemiplegien bei vorbekannter familiärer hemiplegischer Migräne (FHM). Kompliziert wurden die Episoden durch begleitende paranoid-halluzinatorische Syndrome, die wiederholt zu stationären Aufenthalten führten. Unter einer kombinierten neurologischen und psychiatrischen Therapie besserten sich die Episoden regelmäßig innerhalb weniger Wochen. Die prophylaktische Therapie mit Topiramat und Azetazolamid (off-label) schützte den Patienten über mehrere Monate vor neuen Migräneattacken. Nach Absetzen von Azetazolamid wegen fehlender Kostenübernahme entwickelte der Patient innerhalb weniger Tage eine erneute Episode. Die Kosten der Off-label-Behandlung mit Azetazolamid wurden daraufhin von der Familie des Patienten übernommen. Er blieb seither über 8 Monate, abgesehen von einer temporären infektgetriggerten Migräneattacke, klinisch stabil.

Abstract

A 42-year-old patient with cognitive deficits due to childhood meningitis suffered from recurrent episodes of familial hemiplegic migraine. Additionally, he developed concomitant psychotic episodes requiring subsequent in-patient psychiatric treatment. Following combined neurological and psychiatric treatment he always recovered from the episodes within a few weeks time. Prophylactic treatment of migraine using topiramate and acetazolamide (off-label) prevented attacks for several months. When off-label compensation was refused and, as a consequence, the drug discontinued, hemiplegia relapsed within a few days. Hence, acetazolamide was prescribed again and the family paid for the medication. Since that time, the patient did not show severe attacks for at least 8 months apart from a transient attack induced by acute flu-like illness.

Schlüsselwörter

familiäre hemiplegische Migräne - Psychose - Hemiparese - Azetazolamid

Keywords

familial hemiplegic migraine - psychosis - hemiplegia - acetazolamide

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Dr. med. Dr. rer. nat. Horst J. Koch, MFPM DCPSA

Klinik für Psychiatrie und Psychotherapie, HELIOS Klinikum

Gartenstraße 6

08280 Aue

Email: horst.koch@helios-kliniken.de