Inoue Takeshi, Kobayashi Katsuya, Usami Kiyohide, Shimotake Akihiro, Inouchi Morito, Sakai Tatsuya, Ikeda Akio, Takahashi Ryosuke
Department of Neurology, Kyoto University Graduate School of Medicine.
Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine.
Rinsho Shinkeigaku. 2021 Apr 21;61(4):247-252. doi: 10.5692/clinicalneurol.cn-001553. Epub 2021 Mar 25.
We experienced 3 adult patients with intractable focal epilepsy treated by levetiracetam (LEV) as polytherapy, who showed paradoxical effect (PE). Starting dose of LEV was small (62.5, 250 mg/day) and we gradually increased by less than 250 mg/day, every more than 2 weeks. Within 6 months after LEV was added, LEV of 750 to 1,000 mg/day brought reduction of seizure frequency. Serum concentration of LEV was 13.3 and 14.0 μg/ml. In order to obtain better seizure control, LEV was increased up to 1,000-2,500 mg/day (19.3-35.0 μg/ml) within one year, and they developed PE. They all showed increased habitual seizures, occurring in cluster. Once dose of LEV deceased down to what produced the maximum seizure suppression, all of the patients regained the better seizure control. It is most likely that at least in some patients like present 3 cases, PE of LEV may express U curve association between dose and effect and that it was only delineated by slow titration.
我们有3例成年难治性局灶性癫痫患者接受左乙拉西坦（LEV）联合治疗，出现了矛盾反应（PE）。LEV起始剂量较小（62.5、250mg/天），每2周以上逐渐增加剂量，每次增加不超过250mg/天。在加用LEV后的6个月内，每天750至1000mg的LEV使癫痫发作频率降低。LEV血清浓度为13.3和14.0μg/ml。为了更好地控制癫痫发作，1年内将LEV增加至1000 - 2500mg/天（19.3 - 35.0μg/ml），此时出现了矛盾反应。他们均表现为习惯性癫痫发作增加，呈簇状发作。一旦将LEV剂量降至产生最大癫痫抑制作用的剂量，所有患者的癫痫发作又重新得到较好控制。至少在像目前这3例这样的一些患者中，LEV的矛盾反应很可能表现为剂量与效应之间的U型曲线关系，且这种关系只有通过缓慢滴定才能显现出来。
