Dinnerstein Eric, Jobst Barbara C, Williamson Peter D
Section of Neurology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA.
Arch Neurol. 2007 Sep;64(9):1344-6. doi: 10.1001/archneur.64.9.1344.
Various anticonvulsant medications have been associated with paradoxical aggravation of epileptic seizures in therapeutic doses and toxic concentrations. Lamotrigine has been reported to exacerbate seizures and myoclonic seizures in generalized epilepsy in a child with localization-related epilepsy.
To describe lamotrigine intoxication paradoxically producing status epilepticus in an adult with localization-related epilepsy.
Observational case report.
Neurology service, inpatient hospitalization, and outpatient follow-up in a neurology clinic.
A patient with known localization-related epilepsy who ingested an overdose of lamotrigine tablets in a suicide attempt.
None.
Observation of the course of the patient's reaction to lamotrigine intoxication, monitoring of lamotrigine levels, and monitoring of ictal and postictal status.
The patient developed a prolonged convulsive status epilepticus, which was eventually controlled with benzodiazepines. The patient also developed transient obtundation and severe ataxia, all of which resolved completely within 96 hours.
To our knowledge, in addition to being the first case report to describe convulsive status epilepticus after lamotrigine intoxication, this is the first report of the proconvulsant effect of lamotrigine in a case of localization-related epilepsy in an adult. The effects of accidental or suicidal ingestion of lamotrigine tablets seem to be reversible.
多种抗惊厥药物在治疗剂量和中毒浓度时与癫痫发作的反常加重有关。据报道，拉莫三嗪可使一名患有局灶性相关性癫痫的儿童在全身性癫痫中癫痫发作和肌阵挛发作加剧。
描述拉莫三嗪中毒在一名患有局灶性相关性癫痫的成人中反常地引发癫痫持续状态。
观察性病例报告。
神经病学服务、住院治疗以及神经病学门诊的门诊随访。
一名已知患有局灶性相关性癫痫的患者，在自杀未遂时过量服用了拉莫三嗪片。
无。
观察患者对拉莫三嗪中毒的反应过程、监测拉莫三嗪水平以及监测发作期和发作后期状态。
患者出现了长时间的惊厥性癫痫持续状态，最终通过苯二氮䓬类药物得到控制。患者还出现了短暂性意识模糊和严重共济失调，所有这些症状在96小时内完全消失。
据我们所知，这不仅是第一例描述拉莫三嗪中毒后惊厥性癫痫持续状态的病例报告，也是第一例关于拉莫三嗪在一名成人局灶性相关性癫痫病例中促惊厥作用的报告。意外或自杀性摄入拉莫三嗪片的影响似乎是可逆的。
