抗てんかん薬服用者にみられた髄液アミノ酸組成の異常-抗てんかん薬による asterixis との関連-

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Plasma ammonia and 20 amino acids in plasma and in lumbar cerebrospinal fluid (CSF) were measured from two groups of epileptic patients receiving antiepileptic drugs (AED's) who showed asterixis (Group-1; n=9) and those who did not show asterixis (Group-2; n=8), and from neurologically normal controls (Group-3; n=9).<BR>The results showed statistically significant increase in the level of glutamine and decrease in the level of lysine in the CSF of Group-1 as compared with the other two groups.Glutamine-lysine ratio in CSF (GLR) discriminated between Group-1 and the other two groups with accuracy 96.2%.The plasma ammonia level was higher in Group-1 as compared with the other groups but the difference was not statistically significant.<BR>All the patients of Group-1 showed inactivity and EEG slowing as well as asterixis. After the reduction of AED's, those clinical symptoms disappeared and the disturbed CSF amino acid composition was improved with decreased plasma ammonia level.<BR>These results suggest that asterixis induced by AED's is a symptom of encephalopathy associated with reversible disturbances of amino acid metabolism in the brain induced by AED's or secondary hyperammonemia.
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