Carbamazepine/lamotrigine/valproic acid
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Neurological disorders in an elderly patient: case report A 76-year-old woman with juvenile myoclonic epilepsy developed somnolence with valproic acid, exacerbation of generalised idiopathic epilepsy with carbamazepine and increased myoclonus with lamotrigine. The woman was admitted to hospital with a history of falls, myoclonic jerking of the upper limbs and loss of consciousness which responded to IV clonazepam. She had been receiving phenobarbital for an ’old epilepsy’, in addition to levodopa and amantadine for Parkinson’s disease for several years. With a new diagnosis of juvenile myoclonic epilepsy, valproic acid was added to her medications [dosage not stated]. Back at home, she exhibited marked psychomotor slowing and somnolence [time to reaction onset not stated]. Valproic acid was replaced with carbamazepine [dosage not stated] and she was started on citalopram and mianserin. Over the following year, she had many episodes of confusion, falls and numerous seizures, which resulted in two hospital admissions. During the first admission her carbamazepine dosage was increased [dosage not stated], and during the second admission 2 months later, an EEG showed generalised epileptic abnormalities and a generalised photoparoxysmal response, with massive myoclonic jerks in the upper limbs during intermittent light stimulation. On further questioning, she mentioned having had jerking of the upper limbs and seizures since she was an adolescent, but had not received treatment. Carbamazepine was replaced with lamotrigine 50 mg/day, but due to a significant increase in myoclonic jerks [time to reaction onset not stated], lamotrigine was switched to levetiracetam. The woman’s seizures resolved and her EEG abnormalities disappeared. Six months later, she reported no further problems. Nguyen-Michel VH, et al. Idiopathic generalised epilepsies in the elderly: The viewpoint of a geriatrician. Revue Neurologique 165: 924-932, No. 11, Nov 2009. Available from: URL: http://dx.doi.org/10.1016/j.neurol.2009.01.042 [French; 803015111 sumarised from a translation] - France
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Editorial comment: This article reported four cases of generalised epilepsy, but only one was related to drug therapy.
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Reactions 22 May 2010 No. 1302
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