Reactions 993 - 20 Mar 2004

Carbamazepine

Exacerbation of focal reflex proprioceptive seizures:case report

Carbamazepine was associated with a marked exacerbationof focal reflex proprioceptive seizures, in addition tochoreoathetoid dyskinesias, in a 34-year-old man.

During hospitalisation for the treatment of focal-clonicseizures with secondary generalisation, the man begancarbamazepine with the dosage increased up to 400 mg/day,in addition to IM diazepam. Four days after the start oftreatment, a marked increase in the frequency of his focalreflex seizures was noted, with up to 30 seizures daily, but noincrease in generalised tonic-clonic seizures was seen. Hisserum carbamazepine concentration at this time was5.9 µg/mL. Seizures were elicited by antigravitary posture ofthe arms and choreoathetoid dyskinesias of his right handwere sometimes seen before seizures.

Carbamazepine was discontinued and the man was treatedwith clonazepam with the dosage increased up to 2 mg/day.Diazepam was tapered over a 4-day period. His seizures andchoreoathetoid dyskinesias resolved completely within a fewdays and EEG abnormalities resolved. During a 15-year follow-up period, his seizures remained suppressed withclonazepam, but recurred on two occasions after thediscontinuation of clonazepam.

Author comment: "The cause-effect relationship betweenthe use of CBZ [carbamazepine] and the dramatic increase inseizure frequency is probable, and is supported by the seizureincrease soon after CBZ therapy has been started [and] by theseizure decrease after withdrawal of CBZ."Sechi G, et al. Carbamazepine, clonazepam and focal reflex proprioceptiveseizures. Clinical Neuropharmacology 26: 327-330, No. 6, Nov-Dec 2003 -Italy 800970344

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Reactions 20 Mar 2004 No. 9930114-9954/10/0993-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved