Developmental Medicine & Child Neurology

Table of Contents - 2006 - Volume 48, Issue 07  


Case Report

Eye rolling as a manifestation of clobazam toxicity in a child with epilepsy

Sarah E Aylett  a1 a2 c1, Helen Cross  a3 and Dave Berry  a4
a1 Great Ormond Street Hospital NHS Trust, London, UK.
a2 The National Centre for Young People with Epilepsy, Lingfield, UK.
a3 Institute of Child Health (UCL) and Great Ormond Street Hospital NHS Trust, UK.
a4 The Medical Toxicology Unit, Guy's and St Thomas' Hospital Trust, London, UK.

Abstract

A four-year-old male with symptomatic generalized epilepsy presented with ataxia, eye rolling, and episodes of back arching which were of non-epileptic origin following the introduction of clobazam at 0.75mg/kg/day. Concurrent antiepileptic medication was lamotrigine at 13mg/kg/day. Clobazam plasma levels were within the normal range, while N-desmethylclobazam (DCLB) concentrations were between five and seven times above the upper limit of the normal range. The plasma elimination half-life for DCLB was prolonged, suggesting a genetic variability in DCLB metabolism leading to toxicity. Reduction in the dose of clobazam to 0.3mg/kg/day was associated with resolution of the non-epileptic neurological symptoms, reduction in DCLB plasma levels, and maintenance of seizure control.

(Published Online June 19 2006)
(Accepted November 1 2005)


Correspondence:
c1 The National Centre For Young People With Epilepsy, St Piers Lane, Lingfield, Surrey RH7 6PW, UK. E-mail: saylett@ncype.org.uk

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