Combination therapy of levetiracetam and pregabalin to treat juvenile myoclonic epilepsy occurring during treatment of neuropathic pain

Abstract

We present a case of juvenile myoclonic epilepsy (JME) that occurred during pregabalin therapy for neuropathic pain. Pregabalin administration was discontinued, but a subsequent combination of levetiracetam and pregabalin suppressed epileptic seizures and, eventually, pain. A 16-year-old girl reported prolonged, intermittent pain in the area of innervation associated with trocar penetration after treatment of a spontaneous pneumothorax with a trocar catheter. Treatment with pregabalin was effective, but unintended movements of the limbs became apparent. Although the pregabalin was temporarily interrupted, electroencephalography examination revealed spikes and slow wave complexes in general; the patient was diagnosed with JME. As a result, administration of levetiracetam was initiated and pregabalin could be recovered to its previous level. One of the side effects of pregabalin is involuntary movements such as myoclonus; a similar drug, gabapentin, is known to deteriorate JME with single-agent administration. Myoclonus and epileptic seizures are similar and we had difficulty in diagnosis and treatment; however, combination therapy was able to achieve compatibility between pain management and epileptic disease treatment.