Successful treatment of paroxysmal tonic spasms with topiramate in a patient with neuromyelitis optica

Multiple Sclerosis and Related Disorders
Shin IidaHirofumi Kusaka

Abstract

A 49-year-old woman with neuromyelitis optica (NMO) developed severe quadriplegia and frequent paroxysmal tonic spasms (PTS). Carbamazepine, although initially effective against PTS, caused drug eruption and she was unable to continue. PTS re-emerged after discontinuation of carbamazepine and hindered rehabilitation. Then topiramate was started, and PTS promptly disappeared. The patient became able to resume rehabilitation and her activity of daily life improved significantly. Carbamazepine and topiramate have a common pharmacological action to block voltage-gated sodium channels. The action may have contributed to inhibition of ephaptic transmission in the demyelinating lesions by NMO and eventually improved PTS.

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Citations

Mar 16, 2017·Journal of Neurology·Daniel WhittamAnu Jacob
Oct 24, 2020·Nature Reviews. Disease Primers·Sven JariusBrigitte Wildemann
Sep 6, 2021·Journal of Neurology·Hesham AbboudUNKNOWN On-behalf of the Guthy-Jackson Foundation NMO International Clinical Consortium

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