Gabapentin
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Status epilepticus: case report A 57-year-old man with benign adult familial myoclonic epilepsy developed status epilepticus while receiving gabapentin. The man had experienced jerks in his upper extremities and hand tremors since he was 20 years of age, and had received propranolol for several years. His symptoms persisted, and were worse with intermittent light stimulation and upon awakening. His doctor made a diagnosis of essential tremor, and he started to receive gabapentin. It was titrated to a dose of 900 mg/day. Three days later, he developed continuous, fastfrequency, high-amplitude jerking of his trunk and extremities. The symptoms severely impaired his normal activities. Soon after, he developed progressive confusion, disorientation and agitation. Five days later, when the man’s myoclonic status did not respond to IV benzodiazepines, he was hospitalised. He showed high-frequency, erratic, continuous, multifocal myoclonus, occurring asynchronously in different regions of his body. An EEG showed diffuse theta slowing and multifocal spikes, which worsened at low-frequency photic stimulation. A family medical history revealed that he belonged to a large, previously reported kindred segregating benign adult familial myoclonic epilepsy. Laboratory tests showed severe metabolic acidosis, respiratory insufficiency, and elevated transaminases and creatine kinase. He was transferred to the ICU. He was intubated and ventilated, and started receiving thiopental. Gabapentin was stopped. Over the following 24 hours, his condition dramatically improved with normalisation of his laboratory parameters and resolution of his myoclonic status. After 5 days, his EEG normalised. Further electrophysiological investigations confirmed a diagnosis of cortical tremor. Genetic analysis revealed that he carried the haplotype cosegregating with benign adult familial myoclonic epilepsy in his family. The man was discharged receiving levetiracetam, and his symptoms were well controlled. Striano P, et al. Life-threatening status epilepticus following gabapentin administration in a patient with benign adult familial myoclonic epilepsy. Epilepsia 801091168 48: 1995-1998, No. 10, Oct 2007 - Italy
0114-9954/10/1163-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 4 Aug 2007 No. 1163
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