The movement of
calcium into neurons may be the common denominator for the triggering and propagation of seizure activity. We report results of the first double-blind, placebo-controlled, crossover trial with the dihidropyridine
calcium antagonist
nifedipine (
NFD) as adjuvant
therapy in
refractory epilepsy. Twenty-two students (12 male, 10 female, age 17-22 years) attending Lingfield Hospital School received
NFD retard and matched placebo for 8 weeks in 2 doses (20 and 40 mg b.i.d. each for 4 weeks) with a washout period of 8 weeks between treatment phases. In the 20 students who completed the trial, fewer
partial seizures (p less than 0.05) were documented during the first 2 weeks of
NFD administration. Similarly, fewer seizure days (p less than 0.05) were reported in the first month of active treatment. This response was not sustained into the second month of the trial. Blind scoring of EEGs suggested a small improvement with
NFD (p less than 0.05). More patients reported
headache when receiving
NFD (p less than 0.02) than placebo, but heart rate and erect and supine blood pressure remained unaffected. Mean maximum
NFD concentrations were 13.1 +/- 10.4 ng/ml. A weak correlation was noted between total (p less than 0.05) and partial (p = 0.025) seizure numbers and
NFD concentrations following 8 weeks of treatment. This study does not support important
anticonvulsant efficacy for
NFD as adjuvant
therapy for
refractory epilepsy at doses appropriate for the treatment of angina or
hypertension. Further trials are recommended using higher doses of
NFD in less severely affected patients.