Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy
Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy
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DOI：
10.1093/brain/awl047
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发表时间：
2006-05-01
期刊：
影响因子：
14.5
通讯作者：
Genton, P
中科院分区：
文献类型：
--
作者：
Thomas, P;Valton, L;Genton, P
不适当的抗癫痫药物（AEDs）加重特发性全身性癫痫（IGE）综合征越来越被认为是一个严重和常见的问题。不适当的药物治疗引起癫痫持续状态的病例很少有报道。我们回顾性研究了所有患有IGE的成年患者，他们至少服用一种可能加重的AED，他们在8年内发展了视频EEG记录的SE，并且在调整药物治疗后长期结局良好。我们确定了14名患者（7名男性患者），年龄15-46岁，平均癫痫持续时间为16.4年。视频脑电图表现为典型失神SE（ASE）5例，不典型ASE 5例，不典型肌阵挛SE（MSE）3例，典型MSE 1例。癫痫被错误地分类为隐源性部分在8例和隐源性全面在4例。正确诊断为青少年失神癫痫（JAE）6例，青少年肌阵挛性癫痫（JME）4例，癫痫伴觉醒大发作（EGMA）2例，儿童失神癫痫（CAE）2例。所有患者均接受过卡马西平（CBZ）治疗，在转诊前均发生过癫痫发作加重或新的癫痫发作类型。7例患者接受了苯妥英（PHT）、氨己烯酸（VGB）或加巴喷丁（GBP）的综合治疗。潜在的促发因素包括CBZ或CBZ和PHT的剂量增加;开始CBZ、VGB或GBP治疗;以及苯巴比妥剂量减少。停用加重剂和调整药物导致完全控制癫痫发作。这一系列研究表明，IGE中癫痫发作的严重药效学加重可能导致ASE或MSE，通常具有非典型特征。
Aggravation of idiopathic generalized epilepsy (IGE) syndromes by inappropriate antiepileptic drugs (AEDs) is increasingly recognized as a serious and common problem. Precipitation of status epilepticus (SE) by inappropriate medication has rarely been reported. We retrospectively studied all adult patients with IGE taking at least one potentially aggravating AED, who developed video-EEG documented SE over 8 years, and whose long-term outcome was favourable after adjustment of medication. We identified 14 patients (seven male patients) aged 15-46 years with a mean duration of epilepsy of 16.4 years. Video-EEG demonstrated typical absence SE (ASE) in five, atypical ASE in five, atypical myoclonic SE (MSE) in three and typical MSE in one. Epilepsy had been misclassified as cryptogenic partial in eight cases and cryptogenic generalized in four. The correct diagnosis proved to be juvenile absence epilepsy (JAE) in six patients, juvenile myoclonic epilepsy (JME) in four, epilepsy with grand mal on awakening (EGMA) in two and childhood absence epilepsy (CAE) in two. All patients had been treated with carbamazepine (CBZ) and had experienced seizure aggravation or new seizure types before referral. Seven patients had polytherapy with phenytoin (PHT), vigabatrin (VGB) or gabapentin (GBP). Potential precipitating factors included dose increase of CBZ or of CBZ and PHT; initiation of CBZ, VGB or GBP; and decrease of phenobarbital. Withdrawal of the aggravating agents and adjustment of medication resulted in full seizure control. This series shows that severe pharmacodynamic aggravation of seizures in IGE may result in ASE or MSE, often with atypical features.