Carbamazepine
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Carbamazepine Myoclonic jerks and tic-like movements in a child with benign epilepsy Seizures in an 11-year-old boy believed to have benign occipital epilepsy had begun at age 9 years and were completely prevented by treatment with carbamazepine 15 mg/ kg/day. At about 2 weeks after initiating treatment and over the following months uncontrollable, asymmetric and asynchronous myoclonic jerks involving the proXimal muscles of upper and lower limbs were noted. Tic-like movements (sniffing, coughing and sighing) were also reported. The frequency of involuntary movements varied dally, increasing with anxiety and ceasing with sleep. Neurological examinations were repeatedly normal. Dystonic posturing, extrapyramidal and cerebellar signs were not observed and polygraphic studies failed to show EEG changes during myoclonic jerks. Carbamazeplne plasma levels remained between 5.5-9.6 ,ug/ml. Treatment with clobazam 0.8 mg/ kg/day given for 2 weeks reduced but did not eliminate the abnormal movements. Carbamazepine was gradually withdrawn after 17 months and replaced with phenobarbital 3.5 mg/kg/day (plasma level 38.5 ,ug/ml after 25 days). Seizures were controlled and abnormal movements disappeared within a few days of carbamazeplne Withdrawal. Following readministratlon of carbamazepine 15 mg/kg/day for 3 weeks, 6 months later (plasma level 9.5 ,ug/ml) myoclonic Jerks and tics appeared again and disappeared within a few days of drug withdrawal. The temporal relationship between the appearance of tic-like movements and myoclonic jerks and carbamazepine administration Indicated a causal association. 'In conclUSion, appearance of nonepileptic myoclonus in epileptic children treated with caz [carbamazepine 1 should be carefully evaluated to prevent worsening of the clinical picture. The coexistence of other involuntary movements (tics) could suggest the correct diagnosis.' Aguglla U. Zappia M. Oualtrone A Epllepsla 28 515518. Sep·Oct 1987 Reduced serum levels following substitution with a generic product Partial complex seizures in a 30- year-old woman were well controlled with carbamazepine 400 mg/day ('1egretol'): stable morning predose carbamazepine levels ranged 7300- 9700 mg/L. Following substitution of 'Tegretor treatment with generiC carbamazepine, increased seizure actiVity was noted and serum 0157-7271/87/1219-0005/0$01.00/0 © ADIS Press carbamazepine was unmeasurable (limit of sensitiVity 2000 mg/L). Reinstitution of treatment with 'Tegretor 600 mg/day produced a morning predose carbamazepine level of 11,100 mg/L after approximately 72 hours· treatment Decreased bioavallabillty or altered metabolism of carbamazeplne could occur with the generic product. 'Clearly, expedient, detailed pharmacologic studies are critically necessary before considering institution of therapy with a generic compound in patients with a seizure disorder.' Koch G. Allen JP Archives of Neurology 44 578- 579. Jun 1987 REACTIONS' 19 December 1987 5
Transcript of Carbamazepine
Carbamazepine Myoclonic jerks and tic-like movements in a child with benign epilepsy
Seizures in an 11-year-old boy believed to have benign occipital epilepsy had begun at age 9 years and were completely prevented by treatment with carbamazepine 15 mg/ kg/day. At about 2 weeks after initiating treatment and over the following months uncontrollable, asymmetric and asynchronous myoclonic jerks involving the proXimal muscles of upper and lower limbs were noted. Tic-like movements (sniffing, coughing and sighing) were also reported. The frequency of involuntary movements varied dally, increasing with anxiety and ceasing with sleep.
Neurological examinations were repeatedly normal. Dystonic posturing, extrapyramidal and cerebellar signs were not observed and polygraphic studies failed to show EEG changes during myoclonic jerks. Carbamazeplne plasma levels remained between 5.5-9.6 ,ug/ml.
Treatment with clobazam 0.8 mg/ kg/day given for 2 weeks reduced but did not eliminate the abnormal movements. Carbamazepine was gradually withdrawn after 17 months and replaced with phenobarbital 3.5 mg/kg/day (plasma level 38.5 ,ug/ml after 25 days). Seizures were controlled and abnormal movements disappeared within a few days of carbamazeplne Withdrawal. Following readministratlon of carbamazepine 15 mg/kg/day for 3 weeks, 6 months later (plasma level 9.5 ,ug/ml) myoclonic Jerks and tics appeared again and disappeared within a few days of drug withdrawal.
The temporal relationship between the appearance of tic-like movements and myoclonic jerks and carbamazepine administration Indicated a causal association. 'In conclUSion, appearance of nonepileptic myoclonus in epileptic children treated with caz [carbamazepine 1 should be carefully evaluated to prevent worsening of the clinical picture. The coexistence of other involuntary movements (tics) could suggest the correct diagnosis.' Aguglla U. Zappia M. Oualtrone A Epllepsla 28 515518. Sep·Oct 1987
Reduced serum levels following substitution with a generic product
Partial complex seizures in a 30-year-old woman were well controlled with carbamazepine 400 mg/day ('1egretol'): stable morning predose carbamazepine levels ranged 7300-9700 mg/L. Following substitution of 'Tegretor treatment with generiC carbamazepine, increased seizure actiVity was noted and serum
0157-7271/87/1219-0005/0$01.00/0 © ADIS Press
carbamazepine was unmeasurable (limit of sensitiVity 2000 mg/L). Reinstitution of treatment with 'Tegretor 600 mg/day produced a morning predose carbamazepine level of 11,100 mg/L after approximately 72 hours· treatment
Decreased bioavallabillty or altered metabolism of carbamazeplne could occur with the generic product. 'Clearly, expedient, detailed pharmacologic studies are critically necessary before considering institution of therapy with a generic compound in patients with a seizure disorder.'
Koch G. Allen JP Archives of Neurology 44 578-579. Jun 1987
REACTIONS' 19 December 1987 5
