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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy

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Simultaneous toxicities in a child on multiple anticonvulsants.

Sarah Isis R Delima¹, Laurence E Walsh, Meredith R Golomb

¹Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Journal of Child Neurology

|March 18, 2008

Summary

Simultaneous hepatotoxicity and bone marrow toxicity are rare in children on multiple anticonvulsants. A concurrent viral infection may increase the risk of these adverse events, particularly with valproic acid, lamotrigine, and phenytoin.

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Area of Science:

Pediatric Neurology
Clinical Toxicology
Pharmacology

Background:

Anticonvulsant medications are frequently prescribed for pediatric epilepsy.
Polypharmacy with multiple anticonvulsants, including valproic acid, lamotrigine, and phenytoin, is common.
Simultaneous drug toxicities are uncommon but can be severe.

Observation:

A 3.5-year-old child on a regimen of valproic acid, lamotrigine, and phenytoin developed concurrent hepatotoxicity and bone marrow toxicity.
The patient experienced a parainfluenza virus type 3 infection during the onset of these toxicities.
Seizures were managed with lorazepam while anticonvulsants were discontinued.

Findings:

The combination of valproic acid, lamotrigine, and phenytoin may be associated with simultaneous hepatotoxicity and bone marrow toxicity.
Concurrent viral infections, such as parainfluenza virus type 3, might potentiate the risk of these adverse drug reactions.
Discontinuation of the anticonvulsant regimen led to the resolution of both toxicities.

Implications:

Clinicians should be vigilant for rare, simultaneous toxicities in pediatric patients on multiple anticonvulsants.
The potential for drug-drug and drug-infection interactions increasing toxicity risk warrants consideration.
This case highlights the importance of careful monitoring and prompt management of adverse events in pediatric epilepsy treatment.