Successful treatment of paroxysmal tonic spasms with topiramate in a patient with neuromyelitis optica.
A 49-year-old woman with neuromyelitis optica (NMO) developed severe quadriplegia and frequent paroxysmal tonic spasms (PTS). Carbamazepine, although initially effective against PTS, caused drug eruption and she was unable to continue. PTS re-emerged after discontinuation of carbamazepine and hindered rehabilitation. Then topiramate was started, and PTS promptly disappeared. The patient became able to resume rehabilitation and her activity of daily life improved significantly. Carbamazepine and topiramate have a common pharmacological action to block voltage-gated sodium channels. The action may have contributed to inhibition of ephaptic transmission in the demyelinating lesions by NMO and eventually improved PTS.
Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 5731010, Japan.
Shin
S
Iida
Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 5731010, Japan.
Masataka
M
Nakamura
Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 5731010, Japan.
Reika
R
Wate
Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 5731010, Japan. Electronic address: kanekosa@takii.kmu.ac.jp.
Satoshi
S
Kaneko
Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 5731010, Japan.
Hirofumi
H
Kusaka
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D003875:Drug Eruptions; D004421:Dystonia / Q000188:drug therapy* / Q000503:physiopathology* / Q000534:rehabilitation; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation; D026941:Sodium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000077236:Topiramate; D016896:Treatment Outcome
D000927:Anticonvulsants; D026941:Sodium Channel Blockers; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine
Carbamazepine; Ephaptic transmission; Neuromyelitis optica; Paroxysmal tonic spasms; Topiramate