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Oxcarbazepine-induced myoclonic status epilepticus in juvenile myoclonic epilepsy.

Epileptic disorders : international epilepsy journal with videotape (2013-06-19)
Martina Fanella, Gabriella Egeo, Jinane Fattouch, Sara Casciato, Leonardo Lapenta, Alessandra Morano, Anna Teresa Giallonardo, Carlo Di Bonaventura
ABSTRACT

Juvenile myoclonic epilepsy (JME) is a frequent idiopathic generalised epilepsy syndrome with typical clinical and EEG features that can usually be controlled by valproate monotherapy. JME may be underdiagnosed or misdiagnosed; in the latter case, it may be mistaken for partial epilepsy. The incorrect diagnosis of JME is likely to result in inappropriate therapy, which may, in turn, worsen the seizures. While a number of studies have documented that carbamazepine aggravates idiopathic generalised epilepsy, few have shown a worsening of symptoms following the administration of oxcarbazepine (OXC). We report the case of a 44-year-old male affected by JME in which the inappropriate use of OXC precipitated a dramatic worsening of myoclonic seizures. In this case, video-EEG monitoring documented myoclonic status epilepticus with positive and negative myoclonus, correlating with repetitive, continuous, rhythmic, generalised polyspike-and-wave discharges. This is the first case of myoclonic status epilepticus induced by OXC in a patient with JME which is clearly documented by video-EEG. A review of the literature with regards to OXC-induced worsening of seizures is also presented. [Published with video sequences].

MATERIALS
Product Number
Brand
Product Description

Supelco
Carbamazepine, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Carbamazepine, meets USP testing specifications
Sigma-Aldrich
Carbamazepine, powder
Oxcarbazepine, European Pharmacopoeia (EP) Reference Standard
USP
Oxcarbazepine, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Oxcarbazepine, ≥98% (HPLC), solid
Supelco
Oxcarbazepine, analytical standard
Supelco
Oxcarbazepine solution, 1.0 mg/mL in acetonitrile, ampule of 1 mL, certified reference material, Cerilliant®
Supelco
Carbamazepine solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®