Ichioka Ken, Akuzawa Nobuhiro, Takahashi Akio
Department of General Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan.
Division of Neurosurgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan.
SAGE Open Med Case Rep. 2020 Apr 15;8:2050313X20915416. doi: 10.1177/2050313X20915416. eCollection 2020.
An 83-year-old Japanese man with Alzheimer's disease was admitted to our hospital for treatment of hyponatremia resulting from water intoxication. During hospitalization, the patient developed focal impaired awareness seizures, focal to bilateral tonic-clonic seizures, and subsequent status epilepticus. Electroencephalogram during focal impaired awareness seizures showed rhythmic 5-9 Hz theta activity in the right frontotemporal region. Electroencephalogram during focal to bilateral tonic-clonic seizures showed bilateral polyspikes. Electroencephalogram during an interseizure period revealed sharp waves in the right frontal region. Continuous intravenous administration of midazolam was the only effective treatment for status epilepticus. The patient died of aspiration pneumonia on day 58. Hyponatremia-associated status epilepticus is rare; in the present case, multifocal epileptogenicity resulting from Alzheimer's disease and hyponatremia-associated elevation of glutamate levels in the synaptic cleft may have contributed to the onset of focal to bilateral tonic-clonic seizures with subsequent status epilepticus.
一名83岁患有阿尔茨海默病的日本男性因水中毒导致低钠血症入院治疗。住院期间，患者出现局灶性意识障碍性癫痫发作、局灶性至双侧强直阵挛性癫痫发作，随后发展为癫痫持续状态。局灶性意识障碍性癫痫发作时的脑电图显示右侧额颞区有节律性5-9Hz的θ波活动。局灶性至双侧强直阵挛性癫痫发作时的脑电图显示双侧多棘波。发作间期的脑电图显示右侧额叶有尖波。持续静脉注射咪达唑仑是治疗癫痫持续状态的唯一有效方法。患者于第58天死于吸入性肺炎。低钠血症相关性癫痫持续状态罕见；在本病例中，阿尔茨海默病导致的多灶性癫痫源性以及突触间隙中低钠血症相关的谷氨酸水平升高可能促成了局灶性至双侧强直阵挛性癫痫发作并随后发展为癫痫持续状态。
