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Loss of consciousness, following drug intoxication and interaction: case report A 74-year-old woman developed loss of consciousness, secondary to drug intoxication during treatment with perampanel, levetiracetam and lacosamide for temporal lobe epilepsy. Additionally, the perampanel intoxication was triggered by concurrent infection [routes and durations of treatments to reactions onset not stated]. The woman presented temporal lobe epilepsy for 65 years. Her seizures were refractory to carbamazepine and levetiracetam 2000 mg/day. Subsequently, her carbamazepine was replaced with lacosamide 300 mg/day and perampanel 6 mg/day. The dose of levetiracetam was also decreased to 1500 mg/day during admission. Thereafter, her seizures frequency was decreased to several times per 4 weeks, and she was discharged. At discharge, her levetiracetam dose was increased to back to 2000 mg/day and serum perampanel concentration was 524 ng/mL. However, she was hospitalised again due to mental stress after death of her relative. On the basis of clinical symptoms, she was diagnosed with suspected bronchitis. On the current admission, her serum perampanel concentration was found to be 1490 ng/mL. She was treated with peramivir hydrate in spite of negative influenza test. Her appetite was initially decreased but normalised after 3 days, and she was discharged home. During outpatient visit, her lacosamide dose was increased to 350 mg/day. On day 292 after the diagnosis of suspected bronchitis, she developed fever, loss of consciousness and difficulty in standing and she was admitted again. Her CRP level was elevated with negative influenza test. The woman was treated with an unspecified antimicrobial. Her repeat serum perampanel concentration was found to be 2310 ng/mL. Other abnormal findings included hypoalbuminaemia and decreased levels of potassium. Her dose of lacosamide was 400 mg/day. Thereafter, she was diagnosed with secondary bacterial bronchitis and was treated with cefalexin for 5 days resulting in improved consciousness. At discharge, after 51 days of admission, her serum levels of lacosamide and levetiracetam were within normal range and serum perampanel levels was also decreased to 1010 ng/mL. Based on the findings, the perampanel intoxication may have been triggered by her concurrent infection. Also, her serum levels of levetiracetam and lacosamide was not measured during the event. Therefore, a potential levetiracetam and lacosamide intoxication could not be ruled out. Murata T, et al. Perampanel intoxication with impaired consciousness triggered by infection. Clinical Neuropsychopharmacology and Therapeutics 11: 45-46, 2020. Available 803498567 from: URL: http://doi.org/10.5234/cnpt.11.45

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Reactions 29 Aug 2020 No. 1819