外傷後2次性全般化発作，うつ症状に対する多剤投与患者へのレベチラセタムの使用経験

Effect of Levetiracetam on Intractable Secondarily Generalized Seizure and Depression

はじめに

　10余年にわたり欧米諸国にて使用されてきたレベチラセタムが，本邦でも2010年9月に上市された^1,2)。脳のシナプス小胞蛋白（synaptic vesicle protein）2A（SV2A）に結合するという既存の抗てんかん薬とは異なる作用機序から，今後の日本のてんかん医療においても注目されている^2-8)。今回われわれは，外傷を契機とした脳挫傷後，難治性てんかんとこれを誘因としたうつ症状に対して，多数の抗てんかん薬・向精神薬が投与されていた患者を加療した。レベチラセタムを併用することによっててんかんとうつ症状が軽快し，投薬量も大幅に減じることができた症例を経験したので報告する。

Abstract

　Levetiracetam (brand name: E Keppra^®) is a new antiepileptic drug marketed in Japan since 2010^1,2). Clinical reports of its use in Japan are few. Our experience with levetiracetam in a patient with secondarily generalized seizures vielded interesting findings. The patient was a 62-year-old man receiving 4 antiepileptic drugs and 9 psychotropic drugs for treatment of secondarily generalized seizures (due to a cerebral contusion that occured 20 years ago) and associated depressive symptoms, mainly anxiety and insomnia. He begun to wobble and, his increasing gait disturbance led to frequent falls. He recently underwent emergency surgery for acute extradural hematoma due to head contusion. Concomitant administration of levetiracetam, initiated after surgery, resulted in control of the epilepsy, resolution of the depressive symptoms, and reduction of multiple drugs deses. The patient was able to return to normal activity. Control of his epilepsy was probably attributable to the following: (1) the antiepileptic effect of levetiracetam and (2) improvement of the seizure threshold by streamlining multiple concomitant drugs. Although the effect of levetiracetam on depression is unclear, it is worth noting that control of the patient's epilepsy produced an improvement in the symptoms of depression.

（Received: April 8,2011,Accepted: September 8,2011)