- 期刊
自發性脊髓硬膜上血腫患者服用gabapentin後造成舞蹈手指徐動症：病例報告
Choreoathetosis as Side Effect of Gabapentin Therapy in a Patient with Spontaneous Spinal Epidural Hematoma: A Case Report
摘要
自發性脊髓硬膜上血腫是屬於原發性的脊髓硬膜上血腫，不是由其他原因、創傷或是其它錯誤的醫療行為，如腰椎穿刺所造成。自發性脊髓硬膜上血腫在臨床上並不常見，在臨床上常造成脊髓損傷（壓迫）以及神經學上的缺陷。脊髓損傷（壓迫）常常伴隨著神經病變性疼痛，而我們通常搭配兩種以上的藥物，如gabapentin、三環抗憂鬱劑、局部麻醉劑、嗎啡、5羥色胺－去甲腎上腺素再攝取抑制劑類，使用在這一類的病人身上。其中又以gabapentin使用的頻率最高。本報告提出一位自發性脊髓硬膜上血腫合併神經性疼痛的病例，臨床上使用morphine以及imipramine來治療其神經性疼痛。但因止痛效果不佳，故加上gabapentin，五天後劑量達到每日1200 mg時，病人開始出現舞蹈手指徐動症。由於一系列的檢查並沒有其他異樣，故立即終止gabapentin的使用。舞蹈手指徐動症於停藥的隔天就逐漸不明顯，並於停藥後第五天，舞蹈手指徐動症完全消失。回顧以往文獻報告，這一個自發性脊髓硬膜上血腫合併神經性疼痛，可能是第一位因為神經性疼痛而服用gabapentin進而導致舞蹈手指徐動症的病例。
並列摘要
Spontaneous spinal epidural hematoma (SSEH) is attributed to a spinal epidural hematoma which is not caused by incidental, traumatic, or iatrogenic (for example, lumbar puncture) procedures. SSEH is an uncommon condition causing spinal cord lesion and subsequent neurologic deficits. Spinal cord pathology is often followed by neuropathic pain which may be treated with a combination of drug regimens, such as gabapentin, tricyclic antidepressants, topic lidocaine, opioids and serotoninnorepinephrine reuptake inhibitor. We present a case of SSEH with neuropathic pain that was treated with gabapentin, morphine and imipramine. The patient developed choreoathetosis temporally related to adjunctive therapy with gabapentin at dosages of 1200 mg per day. We discontinued the gabapentin treatment and choreoathetosis decreased gradually the next day and disappeared 5 days later. To the best of our knowledge, this is the first case of spinal cord pathology developing involuntary movements due to the side effects of gabapentin therapy for neuropathic pain.
延伸閱讀
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