Bou Nasif Mei, Varade Shweta, Koubeissi Mohamad Z
Department of Neurology, George-Washington University, Washington, DC, USA.
Clin Neurophysiol Pract. 2021 Nov 7;6:281-284. doi: 10.1016/j.cnp.2021.10.004. eCollection 2021.
Levetiracetam (LEV) is widely used for treatment of focal and myoclonic seizures, but reports of LEV toxicity are scarce. Here, we report a rare case of multifocal myoclonus due to LEV toxicity in a patient with chronic renal insufficiency.
A 52-year-old woman with history of chronic kidney disease was admitted to the ICU for sedation and intubation after a cardiac arrest. She developed nonconvulsive status epilepticus that resolved after administration of propofol while receiving LEV 1500 mg twice a day. After holding the propofol infusion, the patient started having multifocal myoclonic jerks, documented on video-EEG recordings with a supratherapeutic level of LEV. After discontinuation of LEV, the myoclonus resolved.
This is a unique manifestation of LEV toxicity, which has been scarce in the literature. It suggests an inverted U-shaped dose-response of the antimyoclonic effect of LEV.
左乙拉西坦（LEV）广泛用于治疗局灶性和肌阵挛性癫痫发作，但关于LEV毒性的报道较少。在此，我们报告1例慢性肾功能不全患者因LEV毒性导致多灶性肌阵挛的罕见病例。
一名有慢性肾脏疾病史的52岁女性在心脏骤停后因镇静和插管入住重症监护病房（ICU）。她出现非惊厥性癫痫持续状态，在每天两次接受1500mg LEV治疗的同时给予丙泊酚后病情缓解。停止输注丙泊酚后，患者开始出现多灶性肌阵挛性抽搐，视频脑电图记录显示LEV水平高于治疗水平。停用LEV后，肌阵挛消失。
这是LEV毒性的一种独特表现，在文献中较为罕见。它提示LEV抗肌阵挛作用的剂量反应呈倒U形。
