Kikuchi Takahiro, Kato Mitsuhiro, Takahashi Nobuya, Nakamura Kazuyuki, Hayasaka Kiyoshi
Department of Pediatrics, Faculty of Medicine, Yamagata University, Yamagata.
No To Hattatsu. 2013 Sep;45(5):375-8.
Here we report a case of a 10-year-old female with unclassified epileptic encephalopathy who showed forced normalization after administration of levetiracetam (LEV). She initially presented with intractable tonic and myoclonic seizures that were observed about 10 times a day along with frequent multifocal sharp and slow wave complexes on electroencephalography (EEG). We were forced to decrease the topiramate dose because of the appearance of nystagmus, and her myoclonic seizures became worse. We added LEV (250 mg/day) and her tonic and myoclonic seizures disappeared one day after initiation of LEV administration. However, she showed hyporesponsiveness and akinesia. The disappearance of paroxysmal discharges on EEG confirmed the diagnosis of forced normalization. Despite continuous administration of LEV, tonic and myoclonic seizures relapsed within a month but her psychotic symptoms resolved simultaneously. To the best of our knowledge, this is the first reported case of forced normalization after LEV administration. It should be noted that LEV may cause forced normalization although it can be started at an adequate dosage.
在此，我们报告一例10岁未分类癫痫性脑病女性患者，其在服用左乙拉西坦（LEV）后出现强制正常化现象。她最初表现为难治性强直和肌阵挛发作，每天约发作10次，脑电图（EEG）上伴有频繁的多灶性尖慢复合波。由于出现眼球震颤，我们被迫减少托吡酯剂量，结果她的肌阵挛发作变得更严重。我们加用LEV（250毫克/天），在开始服用LEV一天后，她的强直和肌阵挛发作消失。然而，她出现了反应迟钝和运动不能。EEG上阵发性放电的消失证实了强制正常化的诊断。尽管持续服用LEV，但强直和肌阵挛发作在一个月内复发，但其精神症状同时缓解。据我们所知，这是首次报道LEV给药后出现强制正常化的病例。应当注意的是，尽管LEV可以以适当剂量开始使用，但它可能会导致强制正常化。
