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Transient “sicca syndrome” during phenobarbital treatment
Journal of the Neurological Sciences 300 (2011) 164
Contents lists available at ScienceDirect
Journal of the Neurological Sciences j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j n s
Short communication
Transient “sicca syndrome” during phenobarbital treatment D. Marino a, A. Malandrini a,⁎, R. Rocchi b, E. Selvi c, A. Federico a a b c
Department of Neurological, Behavioural and Neurosurgical Sciences, Section of Neurological Sciences, University of Siena, Italy Department of Neuroscience, Section of Neurology, University of Siena, Italy Department of Clinic Medicine and Immunological Sciences, Section of Rheumatology, University of Siena, Italy
a r t i c l e
i n f o
Article history: Received 18 March 2010 Received in revised form 17 September 2010 Accepted 23 September 2010 Available online 15 October 2010 Keywords: Sjogren's Syndrome Barbiturate Side-effects
a b s t r a c t Even after the introduction of new antiepileptic drugs, phenobarbital continues to be largely used in the treatment of epilepsy. We report the case of a 59-year-old woman with focal seizures with secondary generalization, treated with phenobarbital with normal serum levels. After thirty days she showed Sjogrenlike symptoms, which resolved after the replaced of phenobarbital with oxcarbazepine. Although many antiepileptic drugs are known to induce autoimmune disorders, a "Sicca Syndrome" has never been reported as an adverse effect of phenobarbital. We think this case report leads to take into consideration the possibility of a drug-induced disorder whenever patients treated with barbiturates develop symptoms suggestive of Sjogren's Syndrome. © 2010 Elsevier B.V. All rights reserved.
1. Introduction Despite the availability of many other antiepileptic drugs, phenobarbital continues to be widely used in the treatment of epilepsy. Known adverse effects include sleepiness, dizziness, ataxia, behavioural disorders and cognitive dysfunction, particularly at high doses. Less common adverse effects include skin rashes, megaloblastic anemia, hepatitis, shoulder hand syndrome and leukopenia. We report the case of a 59-year-old woman, who came to our observation in February 2004 after two focal seizures with secondary generalization. The patient reported sleep deprivation in the last three months due to family problems. She had no history of epilepsy, and no family history of neurological disorders. Neurological examination was normal. Brain MRI showed a small gliotic area in the white matter of the left temporal lobe. Repeated EEGs showed consistently slow waves with sharp appearance in the left temporal lobe. The patient was treated with phenobarbital 100 mg/day, with normal serum drug levels. About thirty days later, she complained of increasingly dry eyes and mouth, causing severe difficulty in chewing and swallowing. After consultation with a rheumatology specialist, a diagnosis of “sicca syndrome” was made. Serological evaluation for anti-RNP, anti-Sm, anti-SS/A, anti-SS/B, antiSc170 and anti-Io1, and routine serum chemistry were negative or normal. Before undertaking biopsy of salivary glands, we gradually replaced phenobarbital with oxcarbazepine (600 mg/day). In about twenty days her symptoms resolved.
⁎ Corresponding author. Department of Neurological, Behavioural and Neurosurgical Sciences. University of Siena, Viale Bracci no.16. Zip code: 53100 City: Siena (Italy). Tel.: + 39 0577 233474; fax: + 39 0577 40327. E-mail address: [email protected] (A. Malandrini). 0022-510X/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2010.09.028
Although many antiepileptic drugs are known to induce autoimmune disorders [1], to our knowledge Sjogren-like symptoms have never been reported as an adverse effect of phenobarbital. The Consensus Group for Diagnosis of Sjogren's Syndrome does not list phenobarbital therapy among exclusion criteria [2,3]. The present case report shows that the possibility of a drug-induced disorder should be considered whenever patients treated with barbiturates develop symptoms suggestive of Sjogren's Syndrome.
Disclosure of Conflicts of Interest None of the authors has any conflict of interest to disclose. The work described is consistent with the Journal's guidelines for ethical publication.
References [1] Chakravarty K. al-Jafari MS Phenytoin-induced pseudo-Sjögren's syndrome. Br J Rheumatol 1996;35(10):1033–4. [2] Gálvez J, Sáiz E, López P, Pina MF, Carrillo A, Nieto A, et al. Diagnostic evaluation and classification criteria in Sjögren's Syndrome. Joint Bone Spine 2009;76(1):44–9. [3] Sánchez-Guerrero J, Pérez-Dosal MR, Cárdenas-Velázquez F, Pérez-Reguera A, Celis-Aguilar E, Soto-Rojas AE, et al. Prevalence of Sjögren's syndrome in ambulatory patients according to the American-European Consensus Group criteria. Rheumatology (Oxf) 2005;44(2):235–40.
Contents lists available at ScienceDirect
Journal of the Neurological Sciences j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j n s
Short communication
Transient “sicca syndrome” during phenobarbital treatment D. Marino a, A. Malandrini a,⁎, R. Rocchi b, E. Selvi c, A. Federico a a b c
Department of Neurological, Behavioural and Neurosurgical Sciences, Section of Neurological Sciences, University of Siena, Italy Department of Neuroscience, Section of Neurology, University of Siena, Italy Department of Clinic Medicine and Immunological Sciences, Section of Rheumatology, University of Siena, Italy
a r t i c l e
i n f o
Article history: Received 18 March 2010 Received in revised form 17 September 2010 Accepted 23 September 2010 Available online 15 October 2010 Keywords: Sjogren's Syndrome Barbiturate Side-effects
a b s t r a c t Even after the introduction of new antiepileptic drugs, phenobarbital continues to be largely used in the treatment of epilepsy. We report the case of a 59-year-old woman with focal seizures with secondary generalization, treated with phenobarbital with normal serum levels. After thirty days she showed Sjogrenlike symptoms, which resolved after the replaced of phenobarbital with oxcarbazepine. Although many antiepileptic drugs are known to induce autoimmune disorders, a "Sicca Syndrome" has never been reported as an adverse effect of phenobarbital. We think this case report leads to take into consideration the possibility of a drug-induced disorder whenever patients treated with barbiturates develop symptoms suggestive of Sjogren's Syndrome. © 2010 Elsevier B.V. All rights reserved.
1. Introduction Despite the availability of many other antiepileptic drugs, phenobarbital continues to be widely used in the treatment of epilepsy. Known adverse effects include sleepiness, dizziness, ataxia, behavioural disorders and cognitive dysfunction, particularly at high doses. Less common adverse effects include skin rashes, megaloblastic anemia, hepatitis, shoulder hand syndrome and leukopenia. We report the case of a 59-year-old woman, who came to our observation in February 2004 after two focal seizures with secondary generalization. The patient reported sleep deprivation in the last three months due to family problems. She had no history of epilepsy, and no family history of neurological disorders. Neurological examination was normal. Brain MRI showed a small gliotic area in the white matter of the left temporal lobe. Repeated EEGs showed consistently slow waves with sharp appearance in the left temporal lobe. The patient was treated with phenobarbital 100 mg/day, with normal serum drug levels. About thirty days later, she complained of increasingly dry eyes and mouth, causing severe difficulty in chewing and swallowing. After consultation with a rheumatology specialist, a diagnosis of “sicca syndrome” was made. Serological evaluation for anti-RNP, anti-Sm, anti-SS/A, anti-SS/B, antiSc170 and anti-Io1, and routine serum chemistry were negative or normal. Before undertaking biopsy of salivary glands, we gradually replaced phenobarbital with oxcarbazepine (600 mg/day). In about twenty days her symptoms resolved.
⁎ Corresponding author. Department of Neurological, Behavioural and Neurosurgical Sciences. University of Siena, Viale Bracci no.16. Zip code: 53100 City: Siena (Italy). Tel.: + 39 0577 233474; fax: + 39 0577 40327. E-mail address: [email protected] (A. Malandrini). 0022-510X/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2010.09.028
Although many antiepileptic drugs are known to induce autoimmune disorders [1], to our knowledge Sjogren-like symptoms have never been reported as an adverse effect of phenobarbital. The Consensus Group for Diagnosis of Sjogren's Syndrome does not list phenobarbital therapy among exclusion criteria [2,3]. The present case report shows that the possibility of a drug-induced disorder should be considered whenever patients treated with barbiturates develop symptoms suggestive of Sjogren's Syndrome.
Disclosure of Conflicts of Interest None of the authors has any conflict of interest to disclose. The work described is consistent with the Journal's guidelines for ethical publication.
References [1] Chakravarty K. al-Jafari MS Phenytoin-induced pseudo-Sjögren's syndrome. Br J Rheumatol 1996;35(10):1033–4. [2] Gálvez J, Sáiz E, López P, Pina MF, Carrillo A, Nieto A, et al. Diagnostic evaluation and classification criteria in Sjögren's Syndrome. Joint Bone Spine 2009;76(1):44–9. [3] Sánchez-Guerrero J, Pérez-Dosal MR, Cárdenas-Velázquez F, Pérez-Reguera A, Celis-Aguilar E, Soto-Rojas AE, et al. Prevalence of Sjögren's syndrome in ambulatory patients according to the American-European Consensus Group criteria. Rheumatology (Oxf) 2005;44(2):235–40.