Efficacy of paroxetine in primary palmoplantar hyperhidrosis occurring with juvenile myoclonic epilepsy

Primary palmoplantar hyperhidrosis (PPH) is believed to be a dysfunction of emotional sweating, with an estimated prevalence of around 3%. Several treatment options including topical antiperspirants, tap water iontophoresis, botulinum toxin injections, oral anticholinergics, and tricyclic antidepressants are available, each with a significant adverse event profile. For the first time, we report a PPH patient with comorbid juvenile myoclonic epilepsy (JME) treated successfully with a combination of paroxetine and divalproex sodium. Paroxetine resulted in improvement in PPH, possibly through its anticholinergic and/or noradrenergic actions. Though the occurrence of PPH and JME together seems to be a chance association, some common frontal lobe mechanisms may be involved that need to be explored further.