Transient Splenial Lesion of the Corpus Callosum after Acute Withdrawal of Antiepileptic Drug: A Case Report

Abstract

Transient lesions at the splenium of the corpus callosum (SCC) have been reported after withdrawal of speciˆc antiepileptic drugs (AED), though the pathophysiology of the lesions remains unclear. We examined and treated a schizophrenic patient who developed a transient SCC lesion after withdrawal of the AED, carbamazepine. Interestingly, the SCC lesion was accompanied by the onset of diabetes insipidus, a state of arginine-vasopressin (AVP) insu‹ciency. Because carbamazepine is shown to potentiate the eŠect of AVP, our case suggests that an insu‹ciency of AVP followed by withdrawal of AED could contribute to the pathogenesis of a transient SCC lesion.

Your Brain on Drugs: Imaging of Drug-related Changes in the Central Nervous System

“…Both withdrawal and administration of some antiepileptic drugs, specifically carbamazepine, have resulted in focal areas of restricted diffusion in the splenium of the corpus callosum in multiple case reports (41,42). These lesions are transient and often silent clinically.…”

“…The pathophysiology is unknown, but multiple hypotheses exist to explain the underlying mechanism of signal intensity alteration in the splenium. These primarily center on the effect of antiepileptic drugs on the fluid-electrolyte balance of the body, specifically the argininevasopressin system (41,42). Patients often do not demonstrate focal neurologic deficits; however, cases of altered consciousness and hallucinations have been reported in the literature (42).…”

Encephalopathy Associated with Psychotropic Drug Therapy

“…Although the pathophysiological mechanisms of this lesion are still obscure, antiepileptics appear to be implicated as pathogenetic or triggering factors at least in some cases. Indeed, the same lesion has been reported also in the non-epileptic patients treated with antiepileptic drugs (Maeda et al, 2003;Honda et al, 2006). Some patients developed the lesion on treatment with antiepileptic drugs (Kim et al, 1999;Polster et al, 2001;Maeda et al, 2003), while others subsequent to withdrawal of them (Polster et al, 2001;Gürtler et al, 2005;Honda et al, 2006).…”

Reversible splenial lesion in the corpus callosum following rapid withdrawal of carbamazepine after neurosurgical decompression for trigeminal neuralgia

“…14 A previously reported patient also had diabetes insipidus, a state of ADH deficiency, during the period when RSL appeared. 8 RSL in patients with AED may indicate transient cerebral oedema 15 mediated by the influence of the rapid change in serum levels of AED. Thus, gradual tapering of the dose is necessary, although one patient was reported to have RSL even after tapering.…”