0
selected
-
1.
Does age affect response to quinidine in patients with KCNT1 mutations? Report of three new cases and review of the literature.
Abdelnour, E, Gallentine, W, McDonald, M, Sachdev, M, Jiang, YH, Mikati, MA
Seizure. 2018;:1-3
Abstract
PURPOSE Gain-of-function mutations in the KCNT1 gene have been reported in a number of drug resistant epilepsy syndromes including Epilepsy of Infancy with Migrating Focal Seizures. Quinidine, a potassium channel blocker, has been proposed as a potential therapeutic agent with only a few patients reported in the literature to have received it. Here we report 3 additional children, with such KCNT1 mutations and refractory seizures, who received quinidine therapy. METHODS Retrospective chart review of 3 children with KCNT1 mutations, of ages 3 months, 9 years and 13 years old. Video-EEG documented seizure type and frequency. Seizure frequency was compared before and after quinidine initiation. We then analyzed seizure response (defined as > 50% reduction in seizure frequency) as it related to age in our 3 reported children, an additional 2 previously seen by us in our center, and an additional 3 reported in the literature (total 8 cases). RESULTS In our report, the 3-month-old infant responded to quinidine, while the two older children did not. Using a cutoff of 4 years of age, review of the total of 8 cases, five from our center, revealed that all patients younger than 4 years responded to quinidine (4/4), while none of the ones older than 4 years did (0/4). CONCLUSION The above-mentioned findings support performance of prospective controlled studies of quinidine efficacy in children with KCNT1 gain-of-function mutations that control for age as a possible variable affecting response.
-
2.
The critical interaction between valproate sodium and warfarin: case report and review.
Zhou, C, Sui, Y, Zhao, W, Dong, C, Ren, L, Song, P, Xu, B, Sun, X
BMC pharmacology & toxicology. 2018;(1):60
Abstract
BACKGROUND Valproic acid (VPA) and warfarin are commonly prescribed for patients with epilepsy and concomitant atrial fibrillation (AF). When VPA and warfarin are prescribed together, clinically important interactions may occur. VPA may replace warfarin from the protein binding sites and result in an abnormally increased anticoagulation effect. This is commonly underrecognized. CASE PRESENTATION In our case, we report a 78-year-old woman with a glioma who presented with status epilepticus. The patient was on warfarin to prevent cardiogenic embolism secondary to AF. Intravenous loading dose of VPA was administered, but international normalized ratio (INR) increased significantly to 8.26. Intravenous vitamin K1 was then given and the patient developed no overt bleeding during the hospitalization. CONCLUSION By reviewing the literature and discussing the critical interaction between valproate sodium and warfarin, we conclude that intravenous VPA and the co-administrated warfarin may develop critical but underrecognized complications due to effects on the function of hepatic enzymes and displacement of protein binding sites.
-
3.
[Lower limb edema during valpromide treatment: case report and literature review].
Gabriel, L, Darcissac, C, Goutelle, S, Sève, P, Vial, T, de La Gastine, B
La Revue de medecine interne. 2015;(10):698-700
Abstract
INTRODUCTION Valpromide and sodium divalproate are indicated in the treatment of maniac episodes of bipolar disorder. These drugs are metabolized into valproic acid. The occurrence of peripheral edema has been described as a very rare adverse reaction of those drugs. CASE REPORT We report the case of a patient treated with valpromide who presented edema of the lower limbs. The increase in furosemide dose allowed regression of edema, and valpromide discontinuation resulted in rapid normalization. Recurrence of mood disorders led to the reintroduction of valpromide, which was associated with recurrence of edema. The definitive withdrawal of valpromide resulted in resolution of edema. CONCLUSION Edema of the lower limbs can be induced by valproate. The mechanism of this reaction is unknown. These edema appear to be reversible upon discontinuation of the drug. Clinicians should be aware of a possible relationship between valproate-derived drugs and peripheral edema.
-
4.
Levetiracetam may worsen myoclonus in patients with juvenile myoclonic epilepsy: case reports.
Babtain, FA
Clinical neuropharmacology. 2012;(4):201-2
Abstract
Levetiracetam was approved for generalized and partial epilepsy in pediatric and adult population. It is also an effective antimyoclonus, but the evidence only supports its use as an adjunctive agent along with other antiepileptic drugs, such as sodium valproate, and it is commonly used in cases with juvenile myoclonic epilepsy. We report here 2 cases with juvenile myoclonic epilepsy who were switched from sodium valproate to levetiracetam to avoid the cosmetic or future teratogenic effect, but this switch was associated with exaggerated myoclonus despite escalating the dose of levetiracetam but resolved completely after reintroducing sodium valproate.
-
5.
[Fatal sodium chloride intoxication--case report and review of the literature].
Buschmann, CT, Lange, F, Tsokos, M
Archiv fur Kriminologie. 2010;(1-2):48-54
Abstract
The authors describe the case of a 63-year-old, female nursing home inhabitant suffering from trisomy 21, who accidentally ingested the anti-epileptic medication of another nursing home inhabitant. After telephone instructions from a specialist in internal medicine, caregivers forced the woman to vomit by means of saline solution and digital manipulation. This caused not only substantial hypernatriaemia but also aspiration pneumonia, from which the woman died after short hospitalization. The potential toxicity by major electrolyte shifts in terms of hypernatriaemia following administration of sodium chloride solution is well known; this measure is medically contraindicated for the induction of vomiting. The mechanisms leading to death in this case are presented, differentiated and discussed against the background of the literature.
-
6.
Sclerosing peritonitis associated with bilateral luteinized thecoma, linked to anticonvulsant therapy.
Levavi, H, Sabah, G, Heifetz, M, Feinmesser, M
European journal of gynaecological oncology. 2009;(6):695-700
Abstract
OBJECTIVE To present a new case of sclerosing peritonitis associated with bilateral luteinized thecoma of the ovaries, linked to anticonvulsant therapy. CASE A 22-year-old patient, receiving carbamazepine for seizures and anxiety attacks presented with shortness of breath, abdominal pain, nausea and vomiting. Clinical and imaging examinations revealed bilateral ovarian masses with massive ascites. At emergency surgery, bilateral ovarian luteinized thecoma with sclerosing peritonitis was found. Due to recurrent, postoperative episodes of small bowel obstruction she was treated with nasogastric suction, intravenous fluids and electrolyte replacement. Total parenteral nutrition was introduced. Since only partial improvement was achieved tamoxifen was administered with resolution of the bowel obstruction. CONCLUSIONS This is the 19th case of sclerosing peritonitis associated with luteinized thecoma of the ovaries and the 3rd to be associated with anticonvulsant therapy. Treatment should be aimed at relief of bowel obstruction symptoms, preferably with conservative methods. Tamoxifen for downregulation of TGF-beta production should be considered as a treatment modality, as it proved to be very helpful in the presented patient.
-
7.
[Successful treatment with cyclosporine of sodium valproate-induced pure red cell aplasia].
Kanda, J, Chonabayashi, K, Watanabe, M, Arima, N, Tsudo, M
[Rinsho ketsueki] The Japanese journal of clinical hematology. 2005;(10):1114-7
Abstract
We report a 67-year-old man who developed pure red cell aplasia (PRCA) during therapy for epilepsy with sodium valproate since April 2004. He was admitted to our hospital because of severe anemia (Hb 5.0g/dl, reticulocyte 0.1%) in August 2004. A bone marrow examination showed marked erythroid hypoplasia and a diagnosis of drug-induced PRCA was made. Because the discontinuation of valproate for one month failed to increase the number of reticulocytes and frequent blood transfusions were necessary, cyclosporine therapy was initiated. Within a week, substantial recovery of the numbers of reticulocytes was obtained, the cyclosporine had, however, to be changed to prednisolone due to the refusal of the patient to continue with it, resulting in the exacerbation of his anemia. After three weeks, cyclosporine therapy was resumed, which achieved rapid and remarkable recovery of red blood cells (Hb 8.9g/dl, reticulocyte 4.9%) within one month. Sixteen cases of valproate-induced PRCA have been reported in the literature and all cases except one recovered only by discontinuing or reducing the administration of valproate. However, our case required cyclosporine therapy in addition to the discontinuation of valproate. These results suggest that not only the direct toxic effect on erythropoiesis but also T lymphocyte-mediated immunological mechanism was involved in the pathogenesis of valproate-induced PRCA.
-
8.
Half pitch lower sound perception caused by carbamazepine.
Konno, S, Yamazaki, E, Kudoh, M, Abe, T, Tohgi, H
Internal medicine (Tokyo, Japan). 2003;(9):880-3
Abstract
We report a 16-year-old woman with secondary generalization of partial seizure, who complained of an auditory disturbance after carbamazepine (CBZ) administration. She had been taking sodium valproate (VPA) from the age of 15. However, her seizures remained poorly controlled. We changed her antiepileptic drug from VPA to CBZ. At 1 week after CBZ administration, she noticed that electone musical performances were heard as a semitone lower. When oral administration of CBZ was stopped, her pitch perception returned to normal. If she had not been able to discern absolute pitch, she might have been unable to recognize her lowered pitch perception. Auditory disturbance caused by CBZ is reversible and very rare.
-
9.
Pyridoxine-dependent seizures and cognition in adulthood.
Baynes, K, Farias, ST, Gospe, SM
Developmental medicine and child neurology. 2003;(11):782-5
Abstract
A case report of neonatal onset pyridoxine-dependent seizures in a male patient with early diagnosis and treatment is presented. The patient's epilepsy was recognized and treated with pyridoxine (vitamin B6) within 8 hours of birth. Treatment has been nearly continuous since that time. This paper reports the results of a full neuropsychological evaluation at age 37 years and MRI completed at age 31 years. Consistent with other case reports in the literature, there was a significant Performance IQ (PIQ) advantage with decreased Verbal IQ (VIQ) and expressive language skills (Full-Scale IQ 71, VIQ 64, PIQ 85). MRI demonstrated characteristic thinning of the posterior corpus callosum. This report provides an example of early treatment that nonetheless results in a mild mental retardation. The similarity of the structural changes on MRI and the cognitive profile of this patient to those of others reported in the literature suggest that the underlying mechanism for both may be the same.
-
10.
Phenytoin and carbamazepine cross reactivity: report of a case and review of literature.
Misra, UK, Kalita, J, Rathore, C
Postgraduate medical journal. 2003;(938):703-4
-
-
Free full text
-
Abstract
Cross reactivity between phenytoin, carbamazepine, and oxcarbazepine is reported. An 8 year old boy with partial seizures developed maculopapular rashes with itching on day 15 of carbamazepine therapy. After stopping carbamazepine, phenytoin 100 mg daily was prescribed two days later. On the 12th day of phenytoin therapy he developed cervical and axillary lymphadenopathy with fever. Lymph nodes revealed reactive hyperplasia. Oxcarbazepine 75 mg twice daily also resulted in oral and mucosa ulceration. The seizures were controlled without any side effects with sodium valproate 200 mg three times a day and gabapentin 300 mg twice a day. Due to the cross reactivity of aromatic anticonvulsants (phenytoin, carbamazepine, and oxcarbazepine), valproate or newer anticonvulsants should be used if a patient has sensitivity to these drugs.