Last modified: 2014-04-03
Abstract
Introduction: Zonisamide is a broad spectrum anti-epilepsy drug (AED), licensed for treatment of adults and children over the age of 6 years with focal epilepsy. We report the occurrence of pancreatitis in child treated with Zonisamide and believe it may have a causal relation.
Case: We present a 5-year boy suffering from refractory generalised chronic epilepsy, characterised by generalised tonic, tonic clonic seizures and absence seizures compatible with symptomatic Lennox Gastaut syndrome. He had acquired microcephaly, severe 4-limb spastic cerebral palsy, cerebral visual impairment and severe cognitive impairment. He was fed by gastrostomy. He had suffered severe perinatal hypoxic ischaemic brain injury at term gestation.
Brain MRI after age 2 years showed extensive multicystic encephalomalacia.
He had been treated with multiple antiepilepsy drugs over the years. He was commenced on Zonisamide. Co-medications included Phenytoin, Phenobarbitone, Clobazam. In the months after commencing Zonisamide he was frequently troubled by severe irritability and excessive crying and his parents felt he was suffering from severe abdominal pains . 8 months after commencing Zonisamide, a CT abdomen showed him to have a pseudo pancreatic cyst. His serum Amylase levels were normal.
Discussion: Pancreatitis has been listed as a rare but serious adverse effect of Zonisamide therapy. This case report illustrates this potential risk.