Motta Ewa, Kazibutowska Zofia, Lorek Andrzej, Januszewski Krzysztof, Gołba Anna, Wianecka Aldona
Katedra i Klinika Neurologii w Katowicach Ochojcu, Slaska Akademia Medyczna, ul. Ziołowa 45/47, 40-635 Katowice.
Neurol Neurochir Pol. 2006 Mar-Apr;40(2):151-5.
Epileptic seizures may be an early symptom of systemic lupus erythematosus, while at the same time some of the epileptic drugs, namely carbamazepine (CBZ), phenytoin (PHT), valproic acid (VPA), ethosuximide (ETM), primidone (PRM), lamotrigine (LTG), zonisamide (ZNS) can cause lupus. A separate clinical problem is the fact that few cases of systemic lupus have as yet been identified by giving antiepileptic drug. We present the case of a 30-year-old woman with frequent simple partial seizures and few secondarily generalized seizures since the age of 18. She was treated with VPA for three years. Then, because of side effects the drug had to be withdrawn and was replaced by CBZ. After eight months duration of the treatment with CBZ, the dose was increased because a secondarily generalized seizure occurred again. After another two months, painful swelling of all joints and leucopenia were observed. During additional studies, LE cells and high titer of ANA antibodies were found. Systemic lupus erythematosus was diagnosed and prednisone therapy was introduced. In spite of the withdrawal of CBZ, the increased titer of ANA antibodies persisted for several years and skin and muscle biopsy performed five years from the onset of clinical symptoms disclosed inflammatory infiltration and presence of IgG and IgM deposits in skin and vessel walls. Control serological examinations, skin and muscle biopsy carried out after eight years of observation and lack of clinical manifestations permitted to exclude a connective tissue disease in our patient.
癫痫发作可能是系统性红斑狼疮的早期症状，而同时一些抗癫痫药物，即卡马西平（CBZ）、苯妥英（PHT）、丙戊酸（VPA）、乙琥胺（ETM）、扑米酮（PRM）、拉莫三嗪（LTG）、唑尼沙胺（ZNS）可引发狼疮。一个单独的临床问题是，通过给予抗癫痫药物而确诊的系统性狼疮病例至今仍很少见。我们报告一例30岁女性患者，自18岁起频繁出现单纯部分性发作，偶有继发性全身性发作。她接受VPA治疗三年。之后，由于出现副作用，该药物不得不停用，换用CBZ。使用CBZ治疗八个月后，因再次出现继发性全身性发作，剂量增加。又过了两个月，观察到所有关节疼痛性肿胀和白细胞减少。在进一步检查中，发现了狼疮细胞和高滴度的抗核抗体（ANA）。诊断为系统性红斑狼疮，并开始使用泼尼松治疗。尽管停用了CBZ，但ANA抗体滴度升高持续了数年，临床症状出现五年后进行的皮肤和肌肉活检显示有炎症浸润，皮肤和血管壁中有IgG和IgM沉积。经过八年观察，进行的对照血清学检查、皮肤和肌肉活检以及无临床表现，使我们能够排除该患者患有结缔组织病。
