Antiepileptics
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Lack of efficacy: 2 case reports In a case series, a 21-year-old man and a 27-year-old woman were described, who exhibited a lack of efficacy during antiepileptic treatment with carbamazepine, clobazam, clonazepam, diazepam, levetiracetam, midazolam, thiamylal sodium, topiramate, valproic acid or zonisamide, indicated for the management of epilepsy [not all routes and dosages stated]. Case 1: A 21-year-old man developed fever one week previously. Initially, he was hospitalised in another hospital, and on the same day, he had systemic tonic convulsions. Afterwards, he developed frequent seizures, and his consciousness was not restored. Therefore, status epilepticus was suspected. Hence (at the current presentation), he was transferred to the hospital on day 7 of his illness. His examination results were normal. He was on various concomitant medications. Based on investigations, a diagnosis of anti-NMDA receptor encephalitis was confirmed. On day 16 of illness, he started receiving levetiracetam 1000mg, which was increased to 2000mg by day 17. However, convulsions recurred. Therefore, carbamazepine 1200mg was added to his treatment regimen, and the dose of levetiracetam was further increased to 3000mg. Despite the therapy, convulsive seizures did not subside. On day 47, carbamazepine was switched to valproic acid. However, due to elevated serum ammonia, valproic acid was stopped. On day 61, he started receiving combination therapy with clonazepam 3g and levetiracetam 3000mg. His seizures were suppressed, and on day 69 he was discharged from the hospital. Two months later, he started experiencing systemic convulsive seizures, along with the left-hand shivering 4–5 times a day. Hence, zonisamide 300mg was included in his treatment regimen. Despite treatment, partial seizures occurred, while the frequency of seizures were decreased. After six months, the frequency of seizures again increased to 7–8 times a month. Subsequently, topiramate 100mg was added to his treatment regimen. The seizure control was poor because of secondarily generalised seizures, requiring re-hospitalisation. An electroencephalogram showed multiple seizures for a long time, with unidentifiable focus. Subsequently, he underwent vagus nerve stimulation. Post-surgery, his seizure frequency decreased, and recovery from the impaired consciousness became faster even when complex partial seizures occurred. Case 2: A 27-year-old woman developed fever 3 days previously. Because of consciousness impairment, she was transferred to the emergency department. She was on various concomitant medications. One day after hospitalisation, she developed systemic tonic-clonic convulsions, which started from the left face. After convulsions, her communication became poor. Hence, she was administered with IV diazepam 20mg. However, her seizures persisted, indicative of status epilepticus. Therefore, she was treated with thiamylal sodium [thiamylal] under artificial respiration management. An EEG showed suppression and burst was reached. Subsequently, carbamazepine 40
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