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儿童拉莫三嗪诱发癫痫发作:病例报告及文献综述

Lamotrigine-induced seizures in a child: case report and literature review.

作者信息

Thundiyil Josef G, Anderson Ilene B, Stewart Pamela J, Olson Kent R

机构信息

School of Medicine, University of California, San Francisco, CA 94143-1369, USA.

出版信息

Clin Toxicol (Phila). 2007;45(2):169-72. doi: 10.1080/15563650601006165.

Abstract

INTRODUCTION

Lamotrigine is an antiepileptic agent. There is only one previous report of a seizure associated with lamotrigine overdose with laboratory confirmation (a 2-year-old girl, lamotrigine level of 3.8 mg/L).

CASE REPORT

A healthy 19-month-old boy ingested an unknown amount of his sister's lamotrigine tablets. Twenty minutes later, the child experienced generalized seizure activity lasting 10 seconds, followed by another brief self-limited seizure. Vitals signs: heart rate 152-207 bpm crying, respiratory rate 26 /min, temperature 95.7 degrees F, and pupils 3mm. The one-hour lamotrigine level = 20.3 mg/L. The child was discharged 24 hours later.

LITERATURE REVIEW

Six previous case reports of lamotrigine poisoning with serum levels, as well as a retrospective review of lamotrigine exposures, are discussed.

CONCLUSION

A case of lamotrigine-induced seizures in a pediatric patient is reported, with a level approximately five times the upper limit of the therapeutic range. The pediatric population may be at increased risk of seizures following lamotrigine poisoning, and serum levels may not be clinically useful for predicting outcome after overdose.

摘要

引言

拉莫三嗪是一种抗癫痫药物。之前仅有一份关于拉莫三嗪过量导致癫痫发作且有实验室确诊的报告(一名2岁女孩,拉莫三嗪血药浓度为3.8毫克/升)。

病例报告

一名健康的19个月大男孩误服了数量不明的他姐姐的拉莫三嗪片。20分钟后,该儿童出现全身性癫痫发作,持续10秒,随后又出现一次短暂的自限性发作。生命体征:哭闹时心率152 - 207次/分钟,呼吸频率26次/分钟,体温95.7华氏度,瞳孔3毫米。1小时后的拉莫三嗪血药浓度 = 20.3毫克/升。该儿童24小时后出院。

文献综述

讨论了之前六份关于拉莫三嗪中毒及血药浓度的病例报告,以及对拉莫三嗪暴露情况的回顾性研究。

结论

报告了一例儿科患者因拉莫三嗪导致癫痫发作的病例,其血药浓度约为治疗范围上限的五倍。儿科人群在拉莫三嗪中毒后癫痫发作风险可能增加,且血药浓度对预测过量用药后的结局可能并无临床意义。

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