Effectiveness of Topiramate in Medically Complicated Patients with Status Epilepticus or Acute Refractory Seizures
A 56-year-old woman was admitted to the hospital with impaired mental status. The patient had a history of multiple myeloma (stage IIIa) diagnosed three years prior to the admission; she received chemotherapy several times, but the disease was refractory to chemotherapy. VAD chemotherapy using vincristine, doxorubicin and dexamethasone was started. However, generalized seizures developed during the third cycle of chemotherapy, and the patient became unresponsive with her eyes deviated to the right side. The routine blood tests revealed pancytopenia (hemoglobin 5.2 g/L, hematocrit 14.4%, WBC 4,570/mm3, and a platelet count of 15,000/mm3), and septic shock developed. Continuous EEG monitoring showed bilateral rhythmic slow waves dominating the frontal area. NCSE was diagnosed and TPM (300 mg bid) was administrated. The epileptiform discharges disappeared after five days, the patient recovered and was responsive. However, the blood culture revealed Staphylococcus epidermidis, and she died on the 49th hospital day from septic shock.