Oxcarbazepine via nasogastric tube in anti-nmda receptor autoimmune encephalitis

• Autores: A. Madrid Paredes, Carlos García Collado, C. Carrascosa Rodríguez, N. Martínez Casanova, M. Ferrit Martín
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 16, Nº. 6, 2014, págs. 14-14
• Idioma: inglés
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• Resumen

  • Objective: Describe treatment options for a case of refractory status epilepticus associated with non-paraneoplastic anti-NMDA receptor encephalitis. Case summary: A 22 year old woman presented a generalized tonic-clonic seizure without clear focal onset and post-critical confusion. She was in non-convulsive status epilepticus.

    Treatment was initiated with intravenous drugs during the 50 days of the status: diazepam, phenytoin, valproic acid, levetiracetam, clonazepam, midazolam,propofol, lacosamide, ketamine, lidocaine and induction of barbiturate coma three times. Oxcarbazepine was administered via feeding tube.

    Thirty days after admission, a further cerebrospinal fluid analysis was anti-NMDA antibody-positive.

    Treatment was initiated with methylprednisolone and immunoglobulins. She continued with clinical status, but electrical brain activity began to fade at the same time that the patient was starting to tolerate enteral nutrition and oxcarbazepine.

    Discussion: Treatment used in status epilepticus is usually by parenteral route.Feeding tube can also be used to administer drugs that cannot be given parenterally.Possibly the patient began to fade because oxcarbazepine began to be absorbed.Clinical guidelines do neither specifically recommend oxcarbazepine nor feeding tube drug administration for the treatment of status epilepticus.

    Conclusion: The possibility of resolving the status by oxcarbazepine gavage opens a window into the use of drugs by this route in the event of failure of Standard therapy