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卡马西平平常用于治疗神经性疼痛,副反应往往发生于神经系统。作者遇到一例病人使用卡马西平后,发生先前未认识的神经系统并发症。女性患者,66岁,一周来左前额和面颊阵发严重的闪击样痛,每次持续几秒钟,没有显视扳机点或可查明的促发因素。神经系统检查和头颈一般检查正常,诊断为三叉神经痛。开始使用苯妥英钠治疗,日量300mg,逐渐增加到500mg。发作明显减少,但未消除。头部增强CT 检查结果正常。三周后联用卡马西平,逐渐增至每日800mg。门诊检查苯妥英钠血清浓度16.5μg/ml,服卡马西平每日600mg,8日后的血清浓度为2.6μg/ml。
Carbamazepine is commonly used to treat neuropathic pain, and side effects often occur in the nervous system. The author encountered a previously unidentified neurological complication after having encountered a patient using carbamazepine. Female patient, 66 years old, had a severe stroke-like pain in her left forehead and buccal burst for a week for a few seconds each without a trigger point or an identifiable trigger. Nervous system examination and head and neck are generally normal, the diagnosis of trigeminal neuralgia. Start using phenytoin sodium treatment, 300mg daily, gradually increased to 500mg. The episode was significantly reduced but not eliminated. Head enhanced CT examination results were normal. Three weeks later with carbamazepine, gradually increased to 800mg daily. Outpatient examination phenytoin sodium serum concentration of 16.5μg / ml, serving carbamazepine 600mg daily, 8 days after the serum concentration of 2.6μg / ml.