A Case of Refractory Epilepsy with Inexplicable Involuntary Body Movement and Hyperammonemia During Treatment.

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Several cases of refractory epilepsy who contracted during infancy with unilateral or general clonic fits with or without tonic convulsion which continue until school age have been reported.<BR>We observed a such case who showed a hyperammonemia and inexplicable involuntary body movement consisted of athetotic, choreatic, dystonic-like movements lasting for one or two hours during the long term treatment in combined medication with carbamazepine, zonisamide, valproic acid, phenytoin and others. Although administration of carbamazepine was discontinued firstly and valproic acid was discontinued secondarily, no successful clinical improvement were obtained. After reducing the dosage of phenytoin, we discontinued its use and continued the treatment with zonisamide alone and then we found an improvement of hyperammonemia and disappearance of the involuntary body movement. Thus, it was suggested that both the involuntary body movement and hyperammonemia in this patient mainly resulted from administration of phenytoin.
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