Gokhale Sankalp, Ramos-Estebanez Ciro
Department of Neurology, Duke University Hospital, Durham, NC 27710, USA.
Case Rep Neurol Med. 2013;2013:713065. doi: 10.1155/2013/713065. Epub 2013 Oct 13.
A 48 year old man with a diagnosis of HIV infection since 1993, on highly active anti-retro viral therapy (HAART) with stable CD4 count and undetectable viral load for years and seizure disorder presented with recurrent drowsiness. His seizures were well controlled on phenobarbitone for years. Repeated laboratory evaluation demonstrated toxic levels of phenobarbitone in his blood. A thorough clinical, psychiatric, laboratory and imaging evaluation did not reveal any obvious etiology for the recurrent barbiturate intoxication in this man. Our findings suggest the possible diagnosis of barbiturate drug automatism in this patient. Though drug automatism is a controversial entity, it merits continued attention. There are recent reports of similar phenomenon with newer sedative agents such as Zolpidem. It is important to be aware of this phenomenon as a possible explanation for recurrent intoxication with barbiturates without a clear etiology for drug overdose.
一名自1993年起被诊断为感染HIV的48岁男性，多年来接受高效抗逆转录病毒疗法（HAART），CD4计数稳定且病毒载量检测不到，同时患有癫痫症，现出现反复嗜睡症状。他的癫痫多年来一直用苯巴比妥控制良好。反复的实验室评估显示他血液中苯巴比妥达到中毒水平。全面的临床、精神科、实验室和影像学评估未发现该男子反复出现巴比妥类药物中毒的明显病因。我们的发现提示该患者可能诊断为巴比妥类药物自动症。尽管药物自动症是一个有争议的实体，但值得持续关注。最近有关于新型镇静剂如唑吡坦出现类似现象的报道。认识到这一现象很重要，因为它可能是巴比妥类药物反复中毒且无明确药物过量病因的一种解释。
