Reactions 1390 - 25 Feb 2012

SOxcarbazepine

Exacerbation of perioral myoclonia withabsences in a child: case report

A boy [age not clearly stated], who was misdiagnosedwith focal epilepsy, experienced exacerbation of perioralmyoclonia with absences while receiving oxcarbazepine.

The 10-year-old boy, who had a history of generalisedconvulsive seizures, presented with a clouded stateassociated with left hemifacial clonia, confusion anddysarthria. During the following year, his parents witnessednumerous short events. A neurological examination wassubsequently performed, and oxcarbazepine [route andinitial dosage not stated] was initiated for a diagnosis offocal cryptogenic epilepsy. Due to persistent seizures, hisoxcarbazepine dosage was increased to 1500 mg twicedaily. The seizures became longer in duration, with oneprogressing to a generalised tonic-clonic seizure [durationof treatment to reaction onset not stated]. At the age of13 years, he was evaluated in an epilepsy centre. Apolygraphic recording with EEG and electromyography wasperformed; interictal brief bursts of bilateral spike-wavesand polyspike-waves were observed, occasionallypredominating over the left or right hemisphere. He wasusually unaware of the seizures, which varied in durationfrom 2-10 seconds. The predominant ictal symptom wasrhythmic contraction of the perioral region. He appeared topout, with protrusion and pursing of the lips, in addition todepression and lateral movement of the commissure.Myoclonia predominated on the left side, involving thementalis, depressor anguli oris, and orbicularis orismuscles, and was often associated with neck myoclonia.Ictal EEG showed epileptiform discharges, which wereirregular, fluctuated in amplitude, and occasionallyfragmented. A diagnosis of perioral myoclonia withabsences was suggested.

Oxcarbazepine was replaced with levetiracetam. Theboy’s seizures decreased a few months later and he had nofurther generalised tonic-clonic seizures. Prolongedperioral myoclonia of approximately 45 minutes durationpersisted.Vrielynck P, et al. Perioral myoclonia with absences and myoclonic statusaggravated by oxcarbazepine. Epileptic Disorders 13: 308-12, No. 3, Sep 2011 -Belgium 803067360

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Reactions 25 Feb 2012 No. 13900114-9954/10/1390-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved