Journal of the Japan Epilepsy Society

Status epilepticus in children is a medical emergency that requires prompt intervention. Diazepam is most commonly administered initially, whereas phenytoin is the anticonvulsant most used subsequently, in Japan. Intravenous diazepam is often associated with respiratory depression and hypotension and duration of its anticonvulsive effect is very brief. During intravenous infusion of phenytoin, cardiopulmonary depression can occur as well as venous complications and appearance of its anticonvulsive action is slow. Midazolam has many clinical and pharmacological advantages compared with other antiepileptic agents. It acts more rapidly and it is safer and more effective. Midazolam should be considered as an initial treatment for status epilepticus in children.

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Carbamazeine (CBZ)-induced onychomadesis is a rare adverse drug reaction. It can often be left unnoticed especially when the symptom is limited to a subtle change of nail plate. We describe a 3-year and 1-month old boy who had reversible onychomadesis. At 12 months of age, the boy encountered first febrile convulsion (FC). The FC occurred repeatedly thereafter and it was classified as complex form FC. At age 2 years and 1 month, the boy had left predominant afebrile clonic hemiconvulsion after taking a bath. We then initiated carbamazeine administration. At age 2 years and 9 months, toenail cleavages at the proximal end of both first toes were found. Two months later, nail shedding of the right first toe occurred. No other systemic skin lesion was present. Blood examination was normal and microscopy of nail scraping revealed no mycete. Abnormal texture of nail plate improved after a gradual withdrawal of CBZ. Based on this finding and the finding of a similar case reported by Mishra et al in 1989, we concluded that the onychomadesis was induced by CBZ.

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