Reactions 1260 - 11 Jul 2009

SCarbamazepine

Oculogyric crisis: case reportA woman developed oculogyric crisis during treatment

with carbamazepine for epilepsy.A 24-year-old woman with bilateral ventriculoperitoneal

(VP) shunts since she was an infant, congenitalhydocephalus and a history of epilepsy was referred to anepilepsy clinic in November 2003 because of episodes ofimpaired balance, nausea, and vomiting associated withheadaches; she had received phenytoin and valproic acid at3 years of age, and carbamazepine had been added whenshe was 6 years old [dosage not stated]. Her episodeslasted from several hours to several days and some of themore severe episodes were associated with upwards eyedeviation. Epilepsy was deemed unlikely and she wasevaluated for possible VP shunt malformation. However,revision of her VP shunt in January and April 2004 did notlead to significant improvement in her symptoms. On re-assessment at the epilepsy clinic in March 2006, she wasexperiencing prolonged episodes of headaches, nausea andvomiting, decreased levels of consciousness, and ataxia2–3 times a week. At this time, she was receivingcontrolled-release carbamazepine (a total of 2100mg),valproic acid and clobazam in divided doses [frequency ofcarbamazepine not clearly stated]. On examination, shefollowed simple commands. None of the episodes inquestion were observed in the clinic. She had a wide-basedgait with moderate ataxia and right spastic hemiparesis.

Oculogyric crisis was suspected and the woman’scarbamazepine dosage was gradually decreased to 600mgtwice daily. During 18 months of follow-up, she wasasymptomatic.

Author comment: "Our patient’s symptoms dramaticallyimproved and completely resolved within weeks of taperingdown the carbamazepine, which is in keeping with publisheddata on carbamazepine-induced oculogyric crisis."AlAzwary NH, et al. Oculogyric crisis masquerading as ventriculoperitoneal shuntdysfunction: case report. Journal of Neurosurgery 109: 944-945, No. 5, Nov 2008 -Canada 801146376

1

Reactions 11 Jul 2009 No. 12600114-9954/10/1260-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved