苯巴比妥致青年癫痫患者胸椎骨折

Thoracic vertebral fracture induced by phenobarbital in a young patient with epilepsy

1例35岁青年男性因病毒性脑炎后继发性癫痫,长期口服卡马西平、奥卡西平、左乙拉西坦、丙戊酸钠等多种抗癫痫药物治疗,癫痫发作一直未完全控制。服药约2年后因癫痫再发改用苯巴比妥(30 mg口服、3次/d)。次年因癫痫发作基本控制患者自行停用苯巴比妥。停药约4年后,患者新型冠状病毒感染后再次癫痫发作,自行服用原剂量苯巴比妥治疗。服药3个月后患者突发自发性多节段胸椎压缩性骨折,给予椎体磷酸钙骨水泥强化术治疗,继续口服苯巴比妥;服药约2年后患者再次发生自发性胸12椎体压缩性骨折,血清25‑羟基维生素D 13.5μg/L,骨钙素8.57μg/L。考虑为苯巴比妥导致的骨质疏松性骨折。停用苯巴比妥,改为吡仑帕奈(2 mg口服、1次/d)治疗,同时给予补充维生素D和钙剂。随访9个月,患者癫痫控制良好,未发生新的骨折事件,血清25‑羟基维生素D 21.6μg/L,骨钙素10.36μg/L。

A 35‑year‑old young male was treated with carbamazepine,oxcarbazepine,levetiracetam,valproate and other antiepileptic drugs for a long time due to secondary epilepsy after viral encephalitis.The epilepsy seizures had not been fully controlled.After about 2 years of treatments,the medication was switched to oral phenobarbital tablets 30 mg thrice daily due to the recurrence of epilepsy.And phenobarbital was discontinued the next year due to well controlled seizures.Four years after drug withdrawal,the patient suffered from coronavirus disease 2019 and the recurrence of epilepsy,and took the original dose of phenobarbital orally again by himself.Three months after medication,the patient had a sudden spontaneous multisegmental thoracic vertebral compression fracture.Vertebral calcium phosphate cement augmentation was performed and phenobarbital was continued.About 2 years after medication,the patient suffered from spontaneous thoracic 12 vertebral compression fracture,with serum 25-hydroxy vitamin D 13.5μg/L and osteocalcin 8.57μg/L.Osteoporotic fractures caused by phenobarbital were considered,and the drug was replaced by oral perampanel tablets 2 mg once daily,and vitamin D and calcium were supplemented.At a follow‑up of 9 months,the patient′s epilepsy was well controlled,no new fracture events occurred,serum 25-hydroxy vitamin D was 21.6μg/L,and osteocalcin levels was 10.36μg/L.