Carbamazepine
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Reactions 1278 - 14 Nov 2009 S Carbamazepine Exacerbation of idiopathic generalised epilepsy: case report A 60-year-old woman with idiopathic generalised epilepsy (IGE) and wicket spikes was misdiagnosed with focal epilepsy; she was subsequently started on carbamazepine, and developed severe exacerbation of her IGE. At the age of 56 years, after having received phenobarbital and valproate, the woman was diagnosed with focal epilepsy after an EEG demonstrated focal sharp waves in her temporal region; carbamazepine 400mg twice daily was initiated. She subsequently experienced one generalised tonic-clonic seizure (GTCS) each month with several traumas [time to reaction onset not stated]. EEGs continued to show sharp waves over her temporal regions, and she received a presurgical referral for refractory focal epilepsy. On presentation, she was receiving carbamazepine 800 mg/day, topiramate, valproate, clobazam and clonazepam. She had received levetiracetam but, due to side effects, it was withdrawn. A long-term video EEG showed sharp temporal theta waves during wakefulness, and typical wicket spikes during drowsiness, stages I and II of non-rapid eye movement (REM) sleep, and REM sleep. A few generalised spike waves were observed during sleep; at awakening, interictal changes increased with bursts of fast generalised spike waves. Carbamazepine was progressively switched to zonisamide, and the woman no longer reported GTCS. She was receiving zonisamide and valproate at a 1-year follow- up; her other medications had been gradually withdrawn. At last follow-up, she remained seizure-free. Author comment: "Due to an incorrect diagnosis of focal epilepsy, [carbamazepine] was prescribed; IGE often gets worse because a wrong type of antiepileptic drugs is prescribed." Crespel A, et al. Wicket spikes misinterpreted as focal abnormalities in idiopathic generalized epilepsy with prescription of carbamazepine leading to paradoxical aggravation. Neurophysiologie Clinique Clinical Neurophysiology 39: 139-142, No. 3, Aug 2009 - France 801154445 1 Reactions 14 Nov 2009 No. 1278 0114-9954/10/1278-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine
Reactions 1278 - 14 Nov 2009
SCarbamazepine
Exacerbation of idiopathic generalised epilepsy:case report
A 60-year-old woman with idiopathic generalisedepilepsy (IGE) and wicket spikes was misdiagnosed withfocal epilepsy; she was subsequently started oncarbamazepine, and developed severe exacerbation of herIGE.
At the age of 56 years, after having receivedphenobarbital and valproate, the woman was diagnosedwith focal epilepsy after an EEG demonstrated focal sharpwaves in her temporal region; carbamazepine 400mg twicedaily was initiated. She subsequently experienced onegeneralised tonic-clonic seizure (GTCS) each month withseveral traumas [time to reaction onset not stated]. EEGscontinued to show sharp waves over her temporal regions,and she received a presurgical referral for refractory focalepilepsy. On presentation, she was receivingcarbamazepine 800 mg/day, topiramate, valproate,clobazam and clonazepam. She had received levetiracetambut, due to side effects, it was withdrawn. A long-termvideo EEG showed sharp temporal theta waves duringwakefulness, and typical wicket spikes during drowsiness,stages I and II of non-rapid eye movement (REM) sleep, andREM sleep. A few generalised spike waves were observedduring sleep; at awakening, interictal changes increasedwith bursts of fast generalised spike waves.
Carbamazepine was progressively switched tozonisamide, and the woman no longer reported GTCS. Shewas receiving zonisamide and valproate at a 1-year follow-up; her other medications had been gradually withdrawn.At last follow-up, she remained seizure-free.
Author comment: "Due to an incorrect diagnosis of focalepilepsy, [carbamazepine] was prescribed; IGE often getsworse because a wrong type of antiepileptic drugs isprescribed."Crespel A, et al. Wicket spikes misinterpreted as focal abnormalities in idiopathicgeneralized epilepsy with prescription of carbamazepine leading to paradoxicalaggravation. Neurophysiologie Clinique Clinical Neurophysiology 39: 139-142,No. 3, Aug 2009 - France 801154445
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Reactions 14 Nov 2009 No. 12780114-9954/10/1278-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
