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Alok K, Lin A, Rahman Dematteo C, Abrar H, Levy Z. Brivaracetam-Associated Rhabdomyolysis Requiring Renal Replacement Therapy: A Case Report and Review of the Literature. Cureus 2024; 16:e58183. [PMID: 38741805 PMCID: PMC11089833 DOI: 10.7759/cureus.58183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Rhabdomyolysis is a rare adverse reaction that has a previously established association with levetiracetam use, which selectively binds the synaptic vesicle glycoprotein 2A (SV2A). Its structural analogue, brivaracetam, is a new third-generation antiseizure medication that has a higher affinity for SV2A, and current data suggests it provides a more favorable adverse event profile. Here, however, we report a case of rhabdomyolysis requiring dialysis in which serum creatine kinase level increased rapidly for several days until brivaracetam was discontinued. The delayed creatine kinase peak, rapid decline upon discontinuation of brivaracetam, and prior association of rhabdomyolysis with levetiracetam strongly suggest a causal relationship. To date, there are three reported cases of brivaracetam-associated rhabdomyolysis in the food and drugs administration adverse event reporting system (FAERS). Despite its favorable side effects profile, the use of brivaracetam may be associated with life-threatening rhabdomyolysis.
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Affiliation(s)
- Khaled Alok
- Neurocritical Care, Northwell Health, Manhasset, USA
| | - Amanda Lin
- Pharmacy, Neurocritical Care, Northwell Health, Manhassett, USA
| | | | - Husain Abrar
- Internal Medicine, Northwell Health, Manhasset, USA
| | - Zachary Levy
- Neurocritical Care, Northwell Health, Manhasset, USA
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Xu W, Dong Z, Wang Y. Peripheral inflammatory biomarkers as predictive tools for HyperCKemia risk assessment post-seizures. J Clin Neurosci 2024; 121:114-118. [PMID: 38387113 DOI: 10.1016/j.jocn.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND This study evaluates the potential of inflammatory biomarkers, especially the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), for early detection of hyperCKemia after seizures. Addressing the challenge of delayed hyperCKemia diagnosis, which can escalate to rhabdomyolysis, this research emphasizes the use of these accessible biomarkers. METHODS Conducted retrospectively, data from October 1, 2022, and October 1, 2023, were extracted from electronic medical records. Following univariate analysis (P-value < 0.05 for selection), Spearman's rank correlation and binary logistics regression were employed to examine the relationship between hyperCKemia and various clinical variables. Receiver operating characteristic curves (ROCs) defined the cut-off values for seizure-related hyperCKemia. RESULTS Among 98 seizure patients, 31 (31.63 %) developed hyperCKemia. Notable differences in leukocytes, neutrophils, CRP, and NLR levels were observed between hyperCKemia and normal CK groups (P < 0.05). Leukocytes, NLR, and CRP correlated with hyperCKemia, exhibiting odds ratios of 1.24 (95 % CI: 1.11-1.39, P < 0.001), 1.03 (95 % CI: 1.01-1.05, P = 0.001), and 1.22 (95 % CI: 1.09-1.35, P = 0.017). The optimal cut-off values were established as 9.78 × 10^9/L for leukocytes, 32.40 mg/L for CRP, and 7.35 for NLR. CONCLUSION Elevated levels of leukocytes, CRP, and NLR post-seizure are strong indicators of hyperCKemia risk, with significant implications for enhancing clinical decision-making and patient care strategies.
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Affiliation(s)
- Wenhao Xu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, China; Anhui Public Health Clinical Center, Hefei 230000, China
| | - Zhong Dong
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, China; Anhui Public Health Clinical Center, Hefei 230000, China
| | - Yu Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, China; Anhui Public Health Clinical Center, Hefei 230000, China.
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Deng Z, Wang S, Wu C. Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study. Front Pharmacol 2023; 14:1197470. [PMID: 37849732 PMCID: PMC10577175 DOI: 10.3389/fphar.2023.1197470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Objective: Rhabdomyolysis is a potentially fatal adverse reaction mostly triggered by certain medications. Few real-world studies have shown a clear association between newer-generation anti-seizure medications (ASMs) and rhabdomyolysis. We sought to quantify the risk and evaluate the clinical features and management of rhabdomyolysis associated with newer-generation ASMs. Methods: Data were retrieved from the US FDA Adverse Event Reporting System database (FAERS) from 2018 to 2022 on newer-generation ASMs to identify rhabdomyolysis events, and disproportionality analyses were conducted by estimating the reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs). Furthermore, case reports from 2012 to 31 December 2022 on newer-generation ASMs-induced rhabdomyolysis were retrieved for retrospective analysis. Results: A total of 1,130 rhabdomyolysis reports from the FAERS database were considered. Levetiracetam had the greatest proportion and the highest positive signal values of rhabdomyolysis. The RORs (95% CIs) for newer-generation ASMs were, in descending order, levetiracetam 8.01 (7.26-8.84), lamotrigine 3.78 (3.25-4.40), oxcarbazepine 3.47 (2.53-4.75), pregabalin 2.75 (2.43-3.12), lacosamide 1.85 (1.29-2.65), topiramate 1.64 (1.25-2.15), and gabapentin 1.32 (1.13-1.55). Twenty-six case reports showed evidence of rhabdomyolysis, and levetiracetam (65.4%) was the most frequently reported agent. The median age was 32 years; typical initial symptoms included muscle weakness (34.8%), myalgia (34.8%), backache (17.4%), fatigue (13.0%) and leg pain (8.7%). The median time to onset of rhabdomyolysis was 2 days. All cases had elevated creatine phosphokinase (CPK), and some cases were accompanied by elevated creatinine (57.1%) and myoglobinuria (53.8%). Cessation of ASMs could lead to complete clinical remission. The median time for creatine phosphokinase (CPK) normalization was 8 days. Conclusion: This study identified 7 newer-generation ASMs with significant rhabdomyolysis reporting associations. Prescribers should be more aware of this risk and teach patients to recognize rhabdomyolysis signs/symptoms early.
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Affiliation(s)
| | | | - Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Sun K, Shi Z, Abudureheman Y, Liu Q, Zhao Y, Zhang X, Lv Q, Zhang Y, Shou S, Jin H. Clinical and Epidemiological Characteristics of Rhabdomyolysis: A Retrospective Study. Int J Clin Pract 2023; 2023:6396576. [PMID: 37808625 PMCID: PMC10558265 DOI: 10.1155/2023/6396576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background Rhabdomyolysis (RM) refers to a clinical syndrome in which muscle cells are damaged by various causes and the clinical manifestations are mainly muscle pain, weakness, and dark urine. Acute kidney injury (AKI) is a serious complication of RM with complex mechanisms and high mortality. Therefore, understanding the pathogenesis and clinical manifestations, early diagnosis and treatment of RM are crucial to improve its prognosis. Method Analysis of medical records of RM patients admitted to Tianjin Medical University General Hospital from October 2019 to October 2022. Statistical software SPSS 25.0 was used to analyze the data. The risk factors of RM-complicated AKI were analyzed by logistic regression. The receiver operating characteristic (ROC) curve was plotted, the area under the curve (AUC) was calculated, and the optimal cutoff value was determined by the Youden index. P < 0.05 indicates a statistically significant difference between the groups. Result Among the 71 patients, the median age of the patients was 53.0 (30.0, 71.0) years and was 2.5 times higher in men than in women. Infection was the most common etiology. History of alcohol consumption, CK, and creatinine were independent influencing factors for AKI due to RM. Logistic regression analysis showed that CK combined with creatinine had a better predictive value than the single index. Conclusion Our study revealed the clinical and laboratory characteristics of RM in the population attending the Tianjin Medical University General Hospital in the last three years, which is a reference for future multicenter, prospective studies.
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Affiliation(s)
- Keke Sun
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenhua Shi
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Intensive Care Unit, PLA 983rd Hospital, Tianjin, China
| | - Yushanjiang Abudureheman
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Critical Care Medicine, Hotan District People's Hospital, Xinjiang, China
| | - Qihui Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yibo Zhao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangqun Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Lv
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Yan Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Wang L, Lu Y, Yang Y, Li H, Wang Y. Elevated body temperature and leukocyte count are associated with elevated creatine kinase after seizures. Heliyon 2022; 8:e12509. [PMID: 36643300 PMCID: PMC9834749 DOI: 10.1016/j.heliyon.2022.e12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/15/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To evaluate the independent risk factors for elevated creatine kinase (hyperCKemia) after seizures. Methods Data included in this retrospective study were obtained from two hospitals from July 1, 2017, to March 31, 2022. Clinical and laboratory data were acquired from the emergency department or within 24 h after patient admission. Variables that exhibited statistical differences (P < 0.05) were selected for further analysis. Associations between body temperature (BT), leukocyte count (LEU), percentage of neutrophils (NEU), and C-reactive protein (CRP) and creatine kinase (CK) levels were assessed using binary logistic regression analysis. Results One hundred twenty-three patients who exhibited seizures were included in the study, and 39 (31.7%) patients exhibited hyperCKemia based on a CK level that was >1.5 times the upper limit of the normal range for CK. No statistical differences were observed among the patient characteristics, seizure-related parameters, or electrolyte levels. However, BT, LEU, NEU, and CRP were elevated in patients with hyperCKemia compared to patients with normal CK levels. Specifically, a BT ≥ 37.5 °C (fever) and LEU >9.5×109/L (elevated LEU) exhibited positive correlations with hyperCKemia, and presented an adjusted OR of 8.87 (95% CI: 2.11-37.24, P = 0.003) and 3.01 (95% CI: 1.12-8.05, P = 0.029), respectively. Conclusion In this study, hyperCKemia occurred in 31.7% of patients after seizures. Fever and elevated LEU were independent risk factors for seizure-related hyperCKemia. Earlier recognition of risks for seizure-related hyperCKemia would be beneficial in taking prophylactic measures.
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Affiliation(s)
- Lei Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanan Lu
- Department of Neurology, Anhui Provincial Hospital, Hefei, China
| | - Yujing Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hanli Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Neurology, Anqing First People's Hospital Affiliated to Anhui Medical University, Anqing, China,Corresponding author.
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Baeza-Trinidad R. Rhabdomyolysis: A syndrome to be considered. Med Clin (Barc) 2021; 158:277-283. [PMID: 34872769 DOI: 10.1016/j.medcli.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
Rhabdomyolysis is characterized by the release of intracellular elements after the destruction of skeletal muscle. Is characterized by the presence of muscle pain, weakness, and dark urine, associated with elevated creatine kinase (CK). The causes related to this syndrome are varied, being traumatic etiology, immobilization, sepsis, drugs and alcohol the most frequent. CK values are used for diagnosis and prognosis, being renal dysfunction the most serious complication. Treatment is based on early and intensive fluid therapy to avoid kidney complications.
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Yoo S, Cho MH, Baek HS, Song JY, Lee HS, Yang EM, Yoo KH, Kim SJ, Shin JI, Lee KH, Ha TS, Jang KM, Lee JW, Kim KH, Cho H, Lee MJ, Suh JS, Han KH, Hyun HS, Ha IS, Cheong HI, Kang HG, Namgoong MK, Cho HK, Oh JH, Lee ST, Kim KS, Lee JH, Park YS, Kim SH. Characteristics of pediatric rhabdomyolysis and the associated risk factors for acute kidney injury: a retrospective multicenter study in Korea. Kidney Res Clin Pract 2021; 40:673-686. [PMID: 34510859 PMCID: PMC8685356 DOI: 10.23876/j.krcp.21.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53.6%) and infection (39.0%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.
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Affiliation(s)
- Sukdong Yoo
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hee Sun Baek
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Ji Yeon Song
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hye Sun Lee
- Department of Pediatrics, National Police Hospital, Seoul, Republic of Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Sun Ha
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung Mi Jang
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jung Won Lee
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kee Hyuck Kim
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Seoul, Republic of Korea
| | - Mee Jeong Lee
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jin-Soon Suh
- Department of Pediatrics, The Catholic University of Korea, Bucheon Saint Mary's Hospital, Bucheon, Republic of Korea
| | - Kyoung Hee Han
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Hye Sun Hyun
- Department of Pediatrics, The Catholic University of Korea, Saint Vincent's Hospital, Suwon, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mee Kyung Namgoong
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye-Kyung Cho
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae-Hyuk Oh
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Taek Lee
- Department of Pediatrics, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Republic of Korea
| | - Young Seo Park
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
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Rhabdomyolysis-Induced Acute Renal Injury in a Schizophrenic Patient. J Crit Care Med (Targu Mures) 2020; 6:249-252. [PMID: 33200097 PMCID: PMC7648442 DOI: 10.2478/jccm-2020-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 01/04/2023] Open
Abstract
Nowadays, schizophrenia is treated with atypical antipsychotics that can determine neuroleptic malignant syndrome or rhabdomyolysis appearance. In addition to trauma and muscular hypoxia, there are some drugs and toxins associated with rhabdomyolysis development, among which olanzapine. A case of severe rhabdomyolysis syndrome, with extremely high levels of serum creatine kinase (CK), followed by acute kidney failure, secondary to olanzapine overdose and prolonged immobilization is outlined. Continuous renal replacement therapy was performed, with a slow clearance of serum CK levels. Under supportive therapy, systemic alkalinisation with volume resuscitation and corticotherapy, patient’s general condition was improved, as well as his lower limb paresis. He followed frequent psychiatric evaluations and psychotherapies, before and after being transferred to a medical service. Rhabdomyolysis diagnosis is difficult in mild cases due to non-specific signs and symptoms, but it also has some typical manifestation, generically called “the rhabdomyolysis syndrome triad”. The treatment is usually supportive; renal replacement therapy is required in the presence of acute kidney injury unresponsive to aggressive volume resuscitation. The systemic myoglobin release is responsible for renal injury. Olanzapine muscle toxicity can lead to severe rhabdomyolysis syndrome complicated with acute kidney injury and multiple organ dysfunction syndrome. Rapid identification and aggressive therapeutic management are essential for improving patients’ outcome and prevent the occurrence of irreversible injuries.
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Liu C, Yuan Q, Mao Z, Hu P, Chi K, Geng X, Hong Q, Sun X. The top 100 most cited articles on rhabdomyolysis: A bibliometric analysis. Am J Emerg Med 2020; 38:1754-1759. [PMID: 32739844 DOI: 10.1016/j.ajem.2020.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Over the past few decades, the incidence of Rhabdomyolysis (RM) has significantly increased. The prognosis is substantially worse if renal failure develops. Many problems remain to be addressed regarding the pathogenesis, prevention, and treatment of RM. The purpose of this study was to identify and characterize the top 100 most cited publications regarding rhabdomyolysis (RM) by performing a bibliometric analysis. METHODS Publications focusing on RM were identified from the Science Citation Index-Expanded (SCI-E) of the Web of Science Core Collection (WoSCC). Bibliographic information was collected, including year of publication, authorship, publishing journals, institution, country of origin and keywords. CiteSpace V5.6.R2 and the Online Analysis Platform of Literature Metrology were used for descriptive analysis. RESULTS The 100 most cited articles were published between 1995 and 2016, with citation numbers ranging from 116 to 904. The United States (60) has been the largest contributor to RM research. Hartford Hospital and University of Texas were found to be the most productive institutions, with five articles each. Thompson, PD, who authored six articles, was the most productive author. The American Journal of Cardiology published the most articles (5), followed by the New England Journal of Medicine (4). The top three co-cited journals were the New England Journal of Medicine (74), Lancet (59) and JAMA (54). CONCLUSIONS This study provides valuable information on the study of RM. These findings may be used to guide clinical decision-making and identify new research fields.
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Affiliation(s)
- Chao Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, China
| | - Qian Yuan
- Department of Biomedical Engineering, Chinese PLA General Hospital, 100853 Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Pan Hu
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Kun Chi
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, China
| | - Xiaodong Geng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, China
| | - Quan Hong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, China.
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Thomas L, Mirza MMF, Shaikh NA, Ahmed N. Rhabdomyolysis: a rare adverse effect of levetiracetam. BMJ Case Rep 2019; 12:12/8/e230851. [PMID: 31451475 DOI: 10.1136/bcr-2019-230851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A 62-year-old previously healthy male was admitted with new onset generalised tonic-clonic seizures. Treatment was initiated with the antiepileptic levetiracetam and he had no further episodes of seizures. Creatine kinase (CPK) level was 1812 IU/L 12-hour postadmission. Despite good hydration, his CPK levels continued to rise dramatically and reached a level of 19 000 IU/L on day 5. This rise was unexplained as he did not have any further seizures and had a normal renal function. In the absence of other risk factors, the rare possibility of levetiracetam being responsible for the disproportionately high CPK was considered. Within 12 hours of withdrawal of levetiracetam, there was a downward trend in the CPK levels, with a 10-fold decrease in CPK levels over the next 4 days. This is only the ninth case reported in literature regarding this rare and potentially serious adverse effect of levetiracetam.
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Affiliation(s)
- Liza Thomas
- Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Niaz Ahmed Shaikh
- Internal Medicine, Dubai Health Authority, Dubai, United Arab Emirates.,Internal Medicine, Rashid Hospital, Dubai, United Arab Emirates
| | - Nahla Ahmed
- Internal Medicine, Dubai Health Authority, Dubai, United Arab Emirates
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Shen XM, Cheng J. Effects of MDR1 (C3435T) Polymorphism on Resistance, Uptake, and Efflux to Antiepileptic Drugs. DNA Cell Biol 2019; 38:250-255. [PMID: 30632789 DOI: 10.1089/dna.2018.4553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
P-glycoprotein (P-gp), encoded by the MDR1 (multidrug resistance 1) gene, involves in the efflux of multiple compounds, such as certain antiepileptic drugs. The aim of this research was to observe the impacts of MDR1 (C3435T) variant on the efflux of phenytoin, carbamazepine, valproate, and phenobarbital in vitro. Stable recombinant LLC-PK1 cell systems transfected with MDR13435C (wild-type allele) and MDR13435T (variant allele) were constructed. The influences of MDR1 (C3435T) variant on the sensitivity, intracellular accumulation, and transepithelial permeability of antiepileptic drugs were assessed. The recombinant MDR13435T cells showed higher resistance to carbamazepine compared with MDR13435C cells in the cytotoxicity assay (p < 0.01). The intracellular accumulation of carbamazepine was significantly decreased in cells transfecting with MDR13435T allele when compared with recombinant MDR13435C cells (p < 0.01). These results also indicate that the efflux activity of P-gp-mediated carbamazepine in recombinant MDR13435T cells was greatly increased compared with MDR13435C cells (p < 0.01), whereas the transport ability of P-gp-dependent phenobarbital in recombinant MDR13435T cells was significantly lower than MDR13435C cells (p < 0.01). However, the effects of MDR1 (C3435T) polymorphism on the resistance, intracellular accumulation, and efflux of phenytoin and valproate were not found in this study. MDR13435T variant allele might be more efficient to transport carbamazepine, whereas reduces the efflux activity of P-gp-mediated phenobarbital. Collectively, MDR1 (C3435T) polymorphism might impact the P-gp activity and antiepileptic agents efflux with drug specificity.
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Affiliation(s)
- Xian-Min Shen
- Department of Pharmacy, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Jin Cheng
- Department of Pharmacy, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Matsudaira T, Terada T, Araki Y, Ikeda H, Obi T, Inoue Y. HyperCKemia associated with lacosamide therapy in an elderly patient with focal onset epilepsy. Seizure 2018; 63:14-16. [DOI: 10.1016/j.seizure.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/23/2018] [Accepted: 10/06/2018] [Indexed: 01/04/2023] Open
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