每日服用苯妥英和左乙拉西坦的苯妥英过量患者急性发作强直性癫痫。

Takeshi Kitamoto, Yasushi Nakamori, Kouichi Hayakawa, Fukuki Saito, Toshihiko Kinoshita
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引用次数: 0

摘要

患者42岁,每日服用苯妥英300 mg,左乙乙胺2000 mg,服用苯妥英28.6 g,转至重症监护中心。入院时血苯妥英浓度为67.9 μg/mL,入院第2天降至53.4 μg/mL。住院第2天多次发生强直性癫痫发作;因此,我们通过鼻胃管恢复左乙拉西坦。此后,再无癫痫发作。我们认为癫痫发作是由于暂时停用左乙拉西坦引起的,因为它没有发生在血液中苯妥英浓度达到峰值并在恢复左乙拉西坦后完全停止的那天。我们认为,为了治疗因过量服用另一种作用机制不同的抗癫痫药物而引起的抽搐发作,有必要立即重新给药,患者通常使用抗癫痫药物。
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Acute onset of a tonic seizure in a phenytoin-overdosed patient who had taken phenytoin and levetiracetam daily.

The 42-year-old woman who had been taking 300 mg phenytoin and 2,000 mg levetiracetam daily took 28.6 g of phenytoin and was transferred to our critical care center. The blood phenytoin concentration was 67.9 μg/mL on admission and decreased to 53.4 μg/mL on hospital day 2. Tonic seizures occurred several times on hospital day 2; thus, we resumed levetiracetam via a nasogastric tube. Thereafter, no further seizures were observed. We thought the seizure to have been caused by temporary withdrawal of levetiracetam because it did not occur on the day when the blood phenytoin concentration peaked and stopped altogether after resumption of levetiracetam. We considered that to treat the convulsion attack resulting from an overdose of the other antiepileptic drug with a different action mechanism, it was necessary to promptly restart the administration of the antiepileptic drug, which the patient was usually administered.

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