Practical Recommendations for Cardiology Follow-Up in Patients Treated with Fenfluramine Based on Expert Opinion and Clinical Experience

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.