Song Hyun-Gul, Nahm Francis Sahngun
Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea.
World J Clin Cases. 2020 Mar 6;8(5):922-927. doi: 10.12998/wjcc.v8.i5.922.
Although few studies have reported hyponatremia due to carbamazepine or oxcarbazepine in patients with epilepsy, no study has investigated cases of carbamazepine- or oxcarbazepine-induced hyponatremia or unsteady gait in patients with neuropathic pain. Herein, we report a case of oxcarbazepine-induced lower leg weakness in a patient with trigeminal neuralgia and summarize the diagnosis, treatment, and changes of clinical symptoms.
A 78-year-old male with a history of lumbar spinal stenosis was admitted to the hospital after he experienced lancinating pain around his right cheek, eyes, and lip, and was diagnosed with trigeminal neuralgia at the right maxillary and mandibular branch. He was prescribed oxcarbazepine (600 mg/d), milnacipran (25 mg/d), and oxycodone/naloxone (20 mg/10 mg/d) for four years. Four years later, the patient experienced symptoms associated with spinal stenosis, including pain in the lower extremities and unsteady gait. His serum sodium level was 127 mmol/L. Assuming oxcarbazepine to be the cause of the hyponatremia, oxcarbazepine administration was put on hold and the patient was switched to topiramate. At subsequent visit, the patient's serum sodium level had normalized to 143 mmol/L and his unsteady gait had improved.
Oxcarbazepine-induced hyponatremia may cause lower extremity weakness and unsteady gait, which should be differentiated from those caused by spinal stenosis.
尽管很少有研究报道癫痫患者因卡马西平或奥卡西平导致低钠血症，但尚无研究调查过患有神经性疼痛的患者出现卡马西平或奥卡西平所致低钠血症或步态不稳的病例。在此，我们报告1例三叉神经痛患者出现奥卡西平所致小腿无力的病例，并总结其诊断、治疗及临床症状变化。
一名78岁男性，有腰椎管狭窄病史，因右侧脸颊、眼睛和嘴唇周围出现刺痛性疼痛入院，被诊断为右侧上颌和下颌支三叉神经痛。他服用奥卡西平（600毫克/天）、米那普明（25毫克/天）和羟考酮/纳洛酮（20毫克/10毫克/天）四年。四年后，患者出现与椎管狭窄相关的症状，包括下肢疼痛和步态不稳。他的血清钠水平为127毫摩尔/升。假定低钠血症由奥卡西平引起，暂停使用奥卡西平，将患者换用托吡酯。在随后的随访中，患者的血清钠水平恢复正常至143毫摩尔/升，步态不稳也有所改善。
奥卡西平所致低钠血症可能导致下肢无力和步态不稳，应与椎管狭窄所致的情况相鉴别。
