Abstract
Carbamazepine (Tegretolr) is used effectively in the treatment of seizure disorders and trigeminal neuralgia. Reported side effects are primarily neurological, occur infrequently and rarely require discontinuation of the drug. We have cared for 3 children in whom 4 episodes of dystonia and opisthotonus occurred in association with carbamazepine use. The patients, a 2 yr. old with microcephaly, a 3 yr. old with cerebral dysgenesis and a 5 yr. old with spastic quadraplegia; all had seizures requiring multiple anticonvulsants. In all 3 patients carbamazepine was introduced and gradually increased to a maximum of 25 mg/kg/d. Symptoms began 2-3 weeks after introduction of therapy and subsided within 3 weeks after discontinuation. In one case a 2nd course of carbamazepine resulted in a return of the dystonia. No hematologic or hepatic abnormalities were noted. Blood levels of concurrently administered anticonvulsants, including phenytoin, were within therapeutic range. A single carbamazepine blood level obtained during one of the episodes was also therapeutic (5.1 mcg/ml). Early reports of carbamazepine's beneficial effect in some dystonic syndromes have not been supported by further clinical trials. It has also been reported to enhance the release of ADH. Our observation of incapacitating but reversible dystonia raises further question about the effects of carbamazepine on the central nervous system. The need exists for an awareness of this complication in physicians caring for neurologically handicapped children.
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