テオフィリン関連非痙攣性てんかん重積状態を呈した脳梗塞の1例

Nonconvulsive Status Epilepticus Associated with Theophylline: A Case Report

症例は87歳，女性。既往歴に気管支喘息。構音障害と右口角下垂で来院し，左内包後脚ラクナ梗塞と診断し，シロスタゾールを開始した。14日目に右上下肢から全身に広がる焦点起始両側強直性間代性発作（FBTCS）を認めた。シロスタゾールを中止しレベチラセタムを開始したが，意識障害，感覚性失語，右片麻痺が残存する非痙攣性てんかん重積状態（NCSE）になり，ラコサミドを追加した。5日目にテオフィリンを中止し，FBTCSは消失した。意識障害と右片麻痺は1週間，感覚性失語は1カ月で消退した。脳梗塞によりテオフィリン中枢神経障害作用が増強したことがNCSEの原因と考えた。

Abstract

An 87-year-old woman was admitted to our hospital because of speech disturbance and right facio-pharyngo-glosso-masticatory diplegia. She had bronchial asthma, was previously diagnosed with cerebral infarction, had experienced two events of convulsive status epilepticus, and was undergoing treatment with theophylline, levetiracetam, and clopidogrel. Head diffusion-weighted magnetic resonance imaging revealed a high-signal area in the left crus posterior capsula interna. For this, we administered cilostazol along with her regular medicines. On day 14, she had tonic-clonic convulsions, extending from the right upper and lower limbs to the whole body. Subsequently, cilostazol was discontinued, and the dose of levetiracetam was increased. However, she developed severe tonic-clonic seizures with right sensory aphasia and right hemiplegia, for which an increased dose of lacosamide was added. When theophylline was discontinued 5 days after the onset of convulsions, the blood concentration of theophylline was 9.7μg/mL. After theophylline was discontinued, tonic-clonic convulsions improved. The disturbance of consciousness and right hemiparesis were improved after one week, while the disturbance of sensory aphasia was improved after one month. We suspect that cerebral infarction may have aggravated the central nervous system damage caused by theophylline, thereby resulting in aminophylline-related non-convulsive status epilepticus.

(Received 20 July 2020; Accepted 27 October 2020; Published 1 March 2021)