Visual Hallucinations Associated with Zonisamide

Akman, Cigdem I.; Goodkin, Howard P.; Rogers, Donald P.; Riviello, James J.

doi:10.1592/phco.23.1.93.31911

Cited by 22 publications

(9 citation statements)

References 13 publications

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“…44 The patients from these two reports had zonisamide levels less than 30 g/mL when they manifested these side effects, thus raising the possibility that children might be more susceptible to these particular central nervous system side effects than adults. 46,47 Other unique side effects have been associated with zonisamide therapy, notably nephrolithiasis, weight loss, and oligohydrosis. Miyamoto et al described a similar experience in 14 of 74 patients on zonisamide who developed psy- chosis, some with obsessive-compulsive behaviors, within a few years of treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience With Zonisamide Monotherapy and Adjunctive Therapy in Children With Epilepsy at a Tertiary Care Referral Center

2005

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We evaluated our clinical experience with zonisamide, a broad-spectrum antiepileptic drug, in a group of children with predominantly medically refractory epilepsy. A retrospective chart review was conducted on patients at our tertiary referral center following Institutional Review Board approval. Observers documented reports of seizure frequency, and seizure types were identified either clinically or by prior video-electroencephalography monitoring. We identified 68 patients (age range 1.9-18.1 years [median 6.9 years]; male to female ratio 1.3:1) treated with zonisamide for 0.7 to 28.9 months; at the last visit, 22% and 78% were on monotherapy and adjunctive therapy, respectively. The median duration of treatment and maintenance dose at the end of the follow-up were 11.2 months and 8.0 mg/kg/day, respectively. Seizure types included generalized (primary generalized tonic-clonic, myoclonic, tonic, atonic, absence) and partial (simple, complex, and secondarily generalized tonic-clonic seizures); 10 (15%) patients had both partial and generalized seizures. Sixteen (25.8%) patients were seizure free, although five of them were already in remission prior to starting zonisamide. Thirteen (21.0%) patients had a > 50% seizure reduction, 10 (16.1%) patients had a < 50% seizure reduction, 14 (22.6%) had no improvement in baseline seizures, and 9 (14.5%) reported having increased seizures. The latter were mostly associated with dosage alterations in concomitant antiepileptic drugs. Common side effects were central nervous system related, including behavioral or psychiatric (23.5%), cognitive dysfunction (12.0%), and sedation (10.3%). Eleven (16.2%) patients ultimately discontinued zonisamide, but only five were strictly due to side effects. Zonisamide is clinically effective against multiple seizure types in a significant proportion of children with epilepsy across a broad age range. Drug discontinuation as a result of side effects is uncommon.

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Section: Discussionmentioning

confidence: 99%

Clinical Experience With Zonisamide Monotherapy and Adjunctive Therapy in Children With Epilepsy at a Tertiary Care Referral Center

2005

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“…Akman et al 24 . describe three patients who experienced complex visual hallucinations and altered mental status after zonisamide treatment was begun or its dosage increased.…”

Section: Visual Side Effectsmentioning

confidence: 99%

Side Effects of Antiepileptics— A Review

et al. 2004

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Older generation antiepileptic drugs like Phenobarbital (Luminal), carbamazepine (Tegretol), phenytoin (Dilantin), and valproic acid (Depakote) have several shortcomings such as suboptimal response rates, significant adverse effects, several drug interactions, and a narrow therapeutic index. New antiepileptic drugs have been developed in the last decade to overcome some of these problems. These newer generation antiepileptics like felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), tiagabine (Gabitril), topiramate (Topamax), and zonisamide (Zonegran) have better tolerability profiles, low interaction potential, and significantly less enzyme inducing or inhibiting properties. As the use of antiepileptic drugs has expanded to include treatment of neuropathic pain, newer side effects have been reported. In addition to the common side effects of antiepileptic drugs, like dizziness, drowsiness, and mental slowing; other side effects like weight gain, metabolic acidosis, nephrolithiasis, angle closure glaucoma, skin rash, hepatotoxicity, colitis, and movement and behavioral disorders, to name a few, have been brought to our attention. This review is an attempt to highlight the features and incidences of some of these side effects.

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“…Hallucinations under antiepileptic are described and also in case of withdrawal 17 : valproic, zonisamide 18 , carbamazepine 19 , levetiracetam 20 , topiramate and anti-N-Methyl-D-Aspartate receptor encephalitis 21 .…”

Section: Discussionmentioning

confidence: 99%

Drug-induced hallucination: a case/non case study in the French Pharmacovigilance Database

Taam¹,

Boissieu²,

Taam

et al. 2015

Eur. J. Psychiat.

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Background and Objectives: Hallucinations are sensory perceptions which occur without external stimuli. There are associated with psychiatric disease but also can be related to organic disease and drug or toxic exposure. The purpose of our study was to investigate the association between exposure to medications and the reporting of hallucinations using data from the spontaneous-reporting French Pharmacovigilance Database (FPVD). Methods: We used the case/noncase method in the FPVD. Cases were all the observations of hallucination with the LLT term "perception disturbances", registered into the FPVD from January 1985 to Jan 2013. Data were expressed as odds ratio (OR) with their 95% confidence intervals. Results: Among the 469,181 reports of adverse effects recorded between 1985 and 2013, 4,086 are hallucinations. For about 50% of these hallucinations were experimented by patient older than 65 years old. A statistically significant OR was found with several medications included rasagiline (OR 17.6 [95%CI 10.4-29.8]), zolpidem (OR 12.9 [95%CI 11.3-14.8]), methylphenidate (OR 9.3 [95%CI 5.9-14.6]) and baclofene (OR 5.4 [95%CI 3.7-7.8]). An increased risk of hallucinations was also observed with non central nervous system drugs, including ertapenem (OR 24.0 [95%CI 14.2-40.5]), voriconazole (OR 12.9[95%CI 10.2-16.5]) and valacyclovir (OR 9.1 [95%CI 6.9-11. 9]). Conclusions: This pharmacoepidemiological study describes an association between drugs and hallucinations. This relationship involves not only some already suspected drugs but also other drugs less known to induce such an adverse reaction. Despite the mandatory limits of this kind of study, these data should lead to special precautions in patient at risk.

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Visual Hallucinations Associated with Zonisamide

Cited by 22 publications

References 13 publications

Clinical Experience With Zonisamide Monotherapy and Adjunctive Therapy in Children With Epilepsy at a Tertiary Care Referral Center

Clinical Experience With Zonisamide Monotherapy and Adjunctive Therapy in Children With Epilepsy at a Tertiary Care Referral Center

Side Effects of Antiepileptics— A Review

Drug-induced hallucination: a case/non case study in the French Pharmacovigilance Database

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