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KMID : 0391520160240020063
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Journal of the Korean Child Neurology Society
2016 Volume.24 No. 2 p.63 ~ p.66
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Lacosamide-associated Valproic Acid Toxicity Following Febrile Illness
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Baek Ji-Hye
Kim Gun-Ha
Byeon Jung-Hye
Eun So-Hee
Eun Baik-Lin
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Abstract
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Valproic acid (VPA) is a widely used anticonvulsant drug having various adverse
effect and drug interaction. In contrast, newer antiepileptic drug, lacosamide
has been known to have minimal drug interaction. We report the second case
of lacosamide-associated valproic acid toxicity presenting as hyperammonemia
following febrile illness. Prior to hospital admission, this 13-year-old girl had been
treated with multiple antiepileptic drugs including valproic acid for 11 years with no
any adverse effect. Lacosamide had recently been added due to poorly controlled
seizures. The patient presented with excessive drowsiness 18 days following an
increase in lacosamide dosage up to 7.5 mg/kg/day. Laboratory tests revealed
elevated levels of VPA(> 150 ug/ml) and hyperammonemia (232 N-μg/dL). Eight
days prior to admission, the patient suffered a 1-day fever as a result of influenza
A infection and did not take an antiviral agent. Lacosamide and valproic acid
treatments were discontinued, while treatment with L-carnitine was added. After
4-days, ammonia levels decreased to 144 N-μg/dL, and the patient became alert. In
conclusion, valproic acid toxicity may occur at any time during the stable course of
medical treatment, though patients may be more susceptible following the addition
of new anti-epileptic drugs or febrile illness.
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KEYWORD
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Lacosamide, Valproic acid, Drug toxicity, Hyperammonemia, Child
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