Zonisamide-Induced Hallucinations : An Anticonvulsant's Psychosis
Copyright © 2021, Al Armashi et al..
Zonisamide is a new-generation anticonvulsant that works by altering the sodium and T-type calcium channels in the brain. It is currently approved for partial seizures, and trials are ongoing to evaluate the effectiveness against mania and chronic pain in adults. Psychosis is a rare side effect with an incidence of 2%. Our patient, a 52-year-old female with a past medical history of osteoarthritis and chronic pain only relieved by zonisamide is brought to the emergency department (ED) after a two-day history of altered mental status, agitation and visual hallucinations. One month prior, she had undergone total knee arthroplasty complicated with right knee cellulitis managed by IV (intravenous) long-term antibiotics of vancomycin and ertapenem. Physical examination was remarkable for disorientation to person, place, and time with intact remainder of the neurological exam. Initial laboratory work was unremarkable and a computerized tomography (CT) scan of the brain showed no acute intracranial abnormalities. The patient was treated as ertapenem-induced with altered mental status and the antibiotic was switched to meropenem upon discharge. Two weeks later, the patient presented to the ED with similar non-resolving complaints. As the patient's symptoms didn't improve after ertapenem discontinuation, the decision was made to stop zonisamide and carefully monitor for possible withdrawal symptoms. Progressively, our patient had a timely resolution of symptoms with a full return to baseline within a week. This case demonstrates the potential severity of zonisamide-induced psychosis. Additional studies are warranted to analyze the mechanism explaining its neurological side effect profile.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Cureus - 13(2021), 7 vom: 18. Juli, Seite e16400 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Al Armashi, Abdul Rahman [VerfasserIn] |
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| Links: |
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| Themen: |
Altered mental status |
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| Anmerkungen: |
Date Revised 03.04.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.7759/cureus.16400 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Copyright © 2021, Al Armashi et al. | ||
| 520 | |a Zonisamide is a new-generation anticonvulsant that works by altering the sodium and T-type calcium channels in the brain. It is currently approved for partial seizures, and trials are ongoing to evaluate the effectiveness against mania and chronic pain in adults. Psychosis is a rare side effect with an incidence of 2%. Our patient, a 52-year-old female with a past medical history of osteoarthritis and chronic pain only relieved by zonisamide is brought to the emergency department (ED) after a two-day history of altered mental status, agitation and visual hallucinations. One month prior, she had undergone total knee arthroplasty complicated with right knee cellulitis managed by IV (intravenous) long-term antibiotics of vancomycin and ertapenem. Physical examination was remarkable for disorientation to person, place, and time with intact remainder of the neurological exam. Initial laboratory work was unremarkable and a computerized tomography (CT) scan of the brain showed no acute intracranial abnormalities. The patient was treated as ertapenem-induced with altered mental status and the antibiotic was switched to meropenem upon discharge. Two weeks later, the patient presented to the ED with similar non-resolving complaints. As the patient's symptoms didn't improve after ertapenem discontinuation, the decision was made to stop zonisamide and carefully monitor for possible withdrawal symptoms. Progressively, our patient had a timely resolution of symptoms with a full return to baseline within a week. This case demonstrates the potential severity of zonisamide-induced psychosis. Additional studies are warranted to analyze the mechanism explaining its neurological side effect profile | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a altered mental status | |
| 650 | 4 | |a anti-epileptic drug | |
| 650 | 4 | |a anticonvulsant | |
| 650 | 4 | |a encephalopathy | |
| 650 | 4 | |a hallucinations | |
| 650 | 4 | |a neurological complication | |
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| 700 | 1 | |a Somoza-Cano, Francisco J |e verfasserin |4 aut | |
| 700 | 1 | |a Patell, Kanchi |e verfasserin |4 aut | |
| 700 | 1 | |a Ravakhah, Keyvan |e verfasserin |4 aut | |
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