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Practical Recommendations for Cardiology Follow-Up in Patients Treated with Fenfluramine Based on Expert Opinion and
Antonio Gil-Nagel1, Leopoldo Pérez de la Isla2, Elena Sanz Pascual3,4,5
1Neurology Department and Epilepsy Program, Ruber Internacional Hospital, Calle La Masó, 38, 28034, Madrid, Spain. agnagel@neurologiaclinica.es.
Introduction:
Fenfluramine (FFA) is approved as an adjunctive treatment for epileptic seizures associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) in patients aged 2 years and older. Owing to its pharmacological characteristics and history of cardiovascular adverse effects, specific cardiological monitoring is required throughout the course of treatment.
Methods:
A set of recommendations for FFA was developed by a multidisciplinary panel comprising specialists in neurology/paediatric neurology, epilepsy, and cardiology (both adult and paediatric). The process involved a literature review, methodological design, working group sessions, and preparation of recommendations structured around three key phases: before treatment, during treatment, and after treatment discontinuation.
Results:
An expert-led algorithm for the use of FFA was developed, helping to establish a common language that promotes a better understanding between cardiologists and neurologists/paediatric neurologists, facilitating the prevention and early management of potential cardiovascular events.
Conclusion:
The management of FFA treatment should be holistic, with coordinated follow-up involving neurologists, paediatric neurologists, and cardiologists. Implementing a structured, expert-based protocol will help enhance treatment safety and optimize clinical outcomes for patients with developmental and epileptic encephalopathies.
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