Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Epilepsia. 2018 Oct;59 Suppl 2:108-112. doi: 10.1111/epi.14490. Epub 2018 Aug 29.
Anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis is a rare autoimmune condition presenting mainly as altered mental state, cognitive dysfunction, and seizure. Antiepileptic drugs (AEDs) are usually initiated to control seizures despite their limited efficacy; however, accumulating clinical experience suggests a high incidence of adverse reactions to AEDs in anti-LGI1 encephalitis. We reviewed the medical records of patients who were diagnosed with anti-LGI1 encephalitis to analyze the adverse effects of AEDs in these patients. Among the 20 patients who were treated with AEDs, 10 (50%) changed their AEDs due to adverse cutaneous drug reaction. Eight of them presented with maculopapular eruption, one with drug rash with eosinophilia and systemic symptoms syndrome, and one with eczema. Causative agents mostly consisted of aromatic AEDs. Oxcarbazepine was discontinued in two additional patients due to hyponatremia. Six patients (30%) discontinued their dose of levetiracetam because of psychiatric manifestations including irritability/aggressive behavior (four patients), insomnia (one patient), and depressive mood (one patient). Clinicians should consider adverse cutaneous drug reaction, psychiatric adverse events, and hyponatremia when selecting AEDs for the treatment of anti-LGI1 encephalitis.
抗亮氨酸丰富胶质瘤失活蛋白 1（LGI1）脑炎是一种罕见的自身免疫性疾病，主要表现为精神状态改变、认知功能障碍和癫痫发作。尽管抗癫痫药物（AEDs）的疗效有限，但通常会启动这些药物来控制癫痫发作；然而，越来越多的临床经验表明，抗 LGI1 脑炎患者对抗癫痫药物的不良反应发生率很高。我们回顾了被诊断为抗 LGI1 脑炎的患者的病历，以分析这些患者中 AED 的不良反应。在接受 AED 治疗的 20 名患者中，有 10 名（50%）因不良皮肤药物反应而改变了 AED。其中 8 名患者出现斑丘疹，1 名出现药物疹伴嗜酸性粒细胞增多和全身症状综合征，1 名出现湿疹。致病药物主要为芳香族 AED。由于低钠血症，另外两名患者停用了奥卡西平。由于出现精神科表现（4 名患者表现为易怒/攻击性行为，1 名患者出现失眠，1 名患者出现抑郁情绪），6 名患者（30%）减少了左乙拉西坦的剂量。当选择 AED 治疗抗 LGI1 脑炎时，临床医生应考虑不良皮肤药物反应、精神科不良反应和低钠血症。
