Dupuytren’s, epilepsy, barbiturates and genes: a chemical love …triangle.

Dupuytren’s has been associated with epilepsy. The type or cause of epilepsy doesn’t seem to matter. What does matter is the specific medication phenobarbitone. Dupuytren’s was not common in epileptics prior to the common use of this medicine, but is very common in people on long term treatment with it: Dupuytren’s will be found in half of men having 20 years of pentobarbitone treatment. This is a huge number, and presents a problem: how can this be reconciled with the concept of an inherited disorder if the incidence of pentobarbitone related Dupuytren’s is larger than the expected Dupuytren gene pool? Does pentobarbital activate Dupuytren genetic or cytokine pathways in the absence of a genetic risk for Dupuytren’s? Once again, more questions than answers.