ISMP Adverse Drug Reactions Dalfampridine-lnduced Seizures,Efavirenz-lnduced Hypersomnolence Leading to Coma and Death,Cerebral Toxoplasmosis with Rituximab,Torsades de Pointes after Low-Dose Aripiprazole,Atypical Antipsychotic-lnduced Sleepwalking

摘要

DALFAMPRIDINE-INDUCED SEIZURES A 50-year-old woman presented with new-onset generalized tonic-clonic seizure 4 days after being started on dalfampridine (Ampyra) 10 mg twice daily and donepezil 5 mg daily simultaneously. One hour after the patient's eighth dose of dalfampridine, her husband found her having a generalized tonic-clonic seizure. She had a history of secondary progressive multiple sclerosis, and her only concurrent chronic medications were glatiramer and baclofen. The patient had no personal or family history of seizures.During the patient's hospital stay, her electroencephalogram (EEG) showed no frank epileptiform activity. Magnetic resonance imaging (MRI) demonstrated atrophy, small vessel disease, and symmetric ventric-ulomegaly with no evidence of mass or recent infarct. The patient had a longstanding history of recurrent urinary tract infections, however the results of her uri-nalysis did not demonstrate an infection.Dalfampridine was immediately discontinued on her admission; once she was medically stable, she was transferred to an acute inpatient rehabilitation unit. The patient did not experience further seizure activity during her hospitalization and throughout her 2 years of follow-up. During this time, no further doses of dalfampridine were administered.