Department of Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
Department of Medicine, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia.
BMJ Case Rep. 2022 Nov 29;15(11):e250911. doi: 10.1136/bcr-2022-250911.
This paper presents the case of a male dialysis patient, with generalised epilepsy, who experienced complications after starting medium cut-off (MCO) dialysis. While receiving haemodiafiltration, the patient's epilepsy had been relatively well controlled using two antiseizure medications (brivaracetam and sodium valproate). However, the patient's seizure frequency increased when he was changed to MCO dialysis. MCO is a new dialysis method that has been developed to allow for better clearance of uraemic toxins through its larger pore size. We hypothesise that using the highly permeable MCO membrane changed the seizure threshold by an unknown mechanism. This is the first reported case to observe increased seizure frequency in a patient receiving MCO dialysis. The case highlights the need for caution when prescribing dialysis methods to patients with epilepsy.
本文报告了一例男性透析患者的病例，该患者患有全身性癫痫，在开始使用中分子截留（MCO）透析后出现并发症。在接受血液透析滤过治疗时，该患者使用两种抗癫痫药物（吡仑帕奈和丙戊酸钠），癫痫得到了较好的控制。然而，当该患者改为 MCO 透析时，其癫痫发作频率增加。MCO 是一种新的透析方法，通过更大的孔径来更好地清除尿毒症毒素。我们假设，使用高通透性的 MCO 膜通过未知机制改变了癫痫发作的阈值。这是首例观察到接受 MCO 透析的患者癫痫发作频率增加的报告病例。该病例强调了在为癫痫患者选择透析方法时需要谨慎。
