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Abstract Details

Cerebral edema with Refractory Intracranial Hypertension Secondary to Lamotrigine Overdose
Neuro Trauma, Critical Care, and Sports Neurology
P14 - Poster Session 14 (8:00 AM-9:00 AM)
13-012
Not applicable
Lamotrigine is an anticonvulsant that blocks voltage-gated sodium channels. It was approved as monotherapy for treating epilepsy and mood disorders. Other than encephalopathy, neurological complications of lamotrigine toxicity are unknown and these are typically observed at serum levels of ≥15??g/ml. Lamotrigine toxicity leads to cytotoxic edema from neuronal swelling secondary to dysfunction of the sodium-potassium ATPase pump. In our patient, the cytotoxic edema caused severe intracranial hypertension with neurological deterioration. Intracranial pressure (ICP) monitoring along with medical management in the neurological intensive care unit lead to a complete recovery. Given the increasing usage of mood-stabilizing medications, physicians should be aware of the neurological complications of lamotrigine toxicity.
Not applicable
30-year-old female with bipolar disorder was found down at home with an empty bottle of lamotrigine.The patient presented to the emergency department with encephalopathy and generalized seizures. Initial computerized tomography (CT) of the brain, electroencephalography (EEG) were unremarkable. Magnetic resonance imaging(MRI) of the brain on day two showed diffuse cerebral edema with sulcal effacement and gyral swelling.She was transferred to a neurological intensive care unit(NICU) for worsening encephalopathy and to rule out non-convulsive status epilepticus.The initial serum lamotrigine level was supratherapeutic at 49.6??/ml (normal range 1-13??/ml). Repeat CT-brain demonstrated diffuse cerebral edema.On day 3, her neurological exam deteriorated with loss of all brainstem reflexes except pupillary reflexes. Intracranial monitor was placed and showed elevated ICP(>30 mmHg) with poor intracranial compliance. She was medically managed with hyperosmolar therapy, paralytics and hypothermia (36C). As the ICP normalized, her neurological exam improved. Day 11,repeat MRI-brain demonstrated improvement in cerebral edema which correlated with normalizing lamotrigine level and patient was discharged to rehabilitation.
Lamotrigine toxicity can lead to global cerebral edema with severe intracranial hypertension. Close neuromonitoring and supportive care in a NICU may lead to good functional recovery.
Authors/Disclosures
Madihah A. Hepburn, MD (Summa Health)
PRESENTER 		Dr. Hepburn has nothing to disclose.
Naresh Mullaguri, MD Dr. Mullaguri has nothing to disclose.
Sunil H. Rathore, MD Dr. Rathore has nothing to disclose.
Vikram Bhinder, MD (University of Toledo) No disclosure on file
Dhimant Dani, MD Dr. Dani has nothing to disclose.