라코사마이드와 관련된 발프로산 독성 1례

초록

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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