A case of resistant convulsion led by hypocalcemia in association with long-term treatment with antiepileptic drugs has been reported.
A 37-year-old, mentally retarded woman was presented with a 12-month history of loss of seizure control, after being seizure-free for 4 years on a fixed regimen of oxcarbazepine, sodium valproate and phenytoin. She had been institutionalized at the age of 7 years and had received anticonvulsant drugs since she was diagnosed with tonic-clonic epilepsy 30 years ago. On investigation, serum concentrations of the anticonvulsant drugs were within the therapeutic range, indicating adequate medication dosages. Serum biochemistry was consistent with hypocalcemia, normal alkaline phosphatase. Seizure control was regained after serum calcium had been normalized with administration of vitamin D and calcium. All possible etiologic factor for hypocalcemia other than antiepileptic therapy were ruled out.
Hypocalcemic seizures are uncommon long-term therapy with AEDs. Loss of seizure control in a patient stabilized on AEDs is an indication to check the patient's calcium status. Phsicians should be aware of this rare but devastating side effect AEDs which influence calcium metabolism and strictly fallow up the course to take necessary precautions in early stage.
Key Words: Hipocalcemia; Antiepileptic Drugs; Emergency Department; Convulsion.
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