Maeda Akiko, Neshige Shuichiro, Katsumata Riho, Nonaka Megumi, Ishibashi Haruka, Maruyama Hirofumi
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN.
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, JPN.
Cureus. 2023 Jun 22;15(6):e40818. doi: 10.7759/cureus.40818. eCollection 2023 Jun.
A 47-year-old man presented with tonic-clonic seizures characterized by convulsions. He repeatedly exhibited seizures despite treatment with four anti-seizure medications. During the titration process of perampanel (PER), the seizures paradoxically increased in intensity and frequency, resulting in trauma. Video electroencephalogram monitoring revealed interictal rapid rhythms and generalized spikes and documented atonic seizures. Thus, the patient was diagnosed with Lennox-Gastaut syndrome. Upon discontinuation of PER, the patient's atonic seizures with falls improved, probably suggesting a paradoxical effect of PER. A non-competitive antagonist selective for AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptors may have caused the weakness and delayed recovery from prolonged atonia that caused injuries.
一名47岁男性出现以抽搐为特征的强直阵挛性发作。尽管使用了四种抗癫痫药物进行治疗，他仍反复出现癫痫发作。在吡仑帕奈（PER）的滴定过程中，癫痫发作强度和频率反而增加，导致了创伤。视频脑电图监测显示发作间期快速节律和广泛性棘波，并记录到失张力发作。因此，该患者被诊断为Lennox-Gastaut综合征。停用PER后，患者的失张力发作伴跌倒情况有所改善，这可能提示了PER的反常效应。一种对AMPA（α-氨基-3-羟基-5-甲基-4-异恶唑丙酸）受体具有选择性的非竞争性拮抗剂可能导致了因长时间失张力引起的无力和恢复延迟，进而造成损伤。
