Phenytoin於疑似粒線體腦病變、乳酸血症及類中風症狀（Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes）病人癲癇治療案例討論

Using Phenytoin for Treating Epilepsy in a Patient With Suspicious Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS): A Case Report

張杏怡(Hsing-Yi Chang) ； 葉爵榮(Jue-Zong Yeh) ； 黃志偉(Chih-Wei Huang) ； 李宜勳(I-Hsun Li)

《臺灣臨床藥學雜誌》 30卷2期 (2022/04) Pp. 185-194

https://doi.org/10.6168/FJCP.202204_30(2).0010

摘要

粒線體腦病變、乳酸血症及類中風症狀（mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes簡稱MELAS）為遺傳性粒線體疾病，臨床表徵常有局部或全身癲癇發作的表現，在很多案例中，抗癲癇藥物常需合併使用治療。本案例為44歲男性因癲癇發作而入院，因反覆癲癇發作及懷疑MELAS，因癲癇藥物valproic acid有粒線體毒性，故調整癲癇藥物使用phenytoin及其他抗癲癇藥物，phenytoin可用於治療大發作、小發作癲癇及癲癇重積狀態，但可能有潛在粒線體毒性，此外phenytoin為治療濃度狹窄的藥品，且和多種藥物有交互作用，臨床上需藉由血中濃度監測以達到良好的治療效果。本篇文章依據文獻查證，進一步探討在MELAS的病患族群phenytoin是否為理想的抗癲癇藥物的選擇並藉由此案例提醒醫療人員phenytoin藥物動力學以及使用注意事項。

關鍵字

MELAS ； 粒線體疾病 ； Seizure ； Phenytoin

並列摘要

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a maternally inherited multisystemic disorder that occurs as a result of mutations in the mitochondrial DNA. Common features of this syndrome include focal or generalized seizures. In many cases, multiple antiepileptic drugs (AEDs) are needed to achieve seizure control. We herein report the case of a 44-year-old man who was hospitalized due to a focal seizure attack. The patient had recurrent focal epileptic seizures after hospitalization, and MELAS syndrome was suspected. Subsequently, in order to limit the iatrogenic mitochondrial toxicity, valproic acid was replaced with an adjusted multiple AED regime including phenytoin. Although phenytoin is often used to treat tonic-clonic (grand mal) or partial seizures and generalized status epilepticus, it may exhibit potential mitochondrial toxicity and affect mitochondrial metabolism. Other drawbacks of phenytoin included its narrow therapeutic range, need for monitoring its concentration in the blood, and its wide-scale drug interactions. Based on the present case study and literature review, further exploration whether phenytoin is an ideal AED option in patients with MELAS is warranted. This case may also raise awareness regarding the pharmacokinetics of phenytoin and precautions for its use.

並列關鍵字

MELAS ； Mitochrondrial Disorder ； Seizure ； Phenytoin