Antiepileptic drugs

Abstract

Lack of efficacy A 64-year-old man exhibited lack of efficacy to levetiracetam, valproate, lacosamide and unspecified benzodiazepines in treatment of anti-AMPAR encephalitis. The man with thymomatous myasthenia gravis, presented with dysautonomia, memory deficits and mood disturbances. AMPAR Glur2 antibodies were found in the CSF. Based on the investigations, he was diagnosed with concurrent anti-AMPAR encephalitis and thymomatous myasthenia with refractory focal status epilepticus. He started receiving IV levetiracetam, valproate, lacosamide and unspecified benzodiazepines. However, no clinical improvement was observed. EEG too showed no improvement. He was then treated with perampanel, immunoglobulins, plasma exchange and methylprednisolone, and he underwent surgical thymectomy. Consequently, a clinical benefit was obtained.