Carbamazepine
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Seizures secondary to hyponatraemia in an elderly patient: case report A 74-year-old man developed seizures secondary to hyponatraemia after starting carbamazepine following an initial seizure episode. Following admission for aphasia and right hemiparesis, a brain CT revealed an acute ischaemia lesion in the man’s temporal lobe. Around 36 hours postadmission, he experienced a generalised seizure. An EEG showed aspecific left hemisphere abnormalities and carbamazepine 100mg twice daily was started. Concomitant medications included atorvastatin, clopidogrel, esomeprazole and ramipril. Although his presenting symptoms had greatly improved 10 days postadmission, he had episodes of drowsiness, gait instability, slurred speech, absences and urine loss. Laboratory testing revealed mild hyponatraemia (124 mEq/L). During post-stroke rehabilitation, he experienced seizures at an increasing frequency [duration of therapy before reaction not stated] and his carbamazepine dosage was increased to 200mg twice daily, without benefit. A repeat EEG showed diffuse slowing discharges with no evident epileptic signs, while repeat testing revealed a sodium level of 117 mEq/L. Carbamazepine was discontinued and the man’s hyponatraemia resolved. Thereafter, he received no further antiepileptic medication and had no more seizures. Author comment: "[C]arbamazepine can paradoxically induce seizure by worsening hyponatremia". Maiorana E, et al. Carbamazepine-Induced Seizures. 2010 Annual Scientific Meeting of the American Geriatrics Society : abstr. A3, 12 May 2010. Available from: URL: http://www.americangeriatrics.org/annual%5fmeeting/ [abstract] 803019499 Italy
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Reactions 12 Jun 2010 No. 1305
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