■症例から学ぶ
包括的てんかん診療における薬剤師業務の展開
浦 裕之1, 4, 太組 一朗2, 藤野 修3, 福田 恵子4, 小林 士郎5, 吉田 大蔵2, 高橋 弘2, 寺本 明6, 渡辺 雅子7, 定本 清美1
1東邦大学薬学部臨床病態学研究室
2日本医科大学武蔵小杉病院脳神経外科
3日本医科大学千葉北総病院小児科
4日本医科大学千葉北総病院薬剤部
5日本医科大学千葉北総病院脳神経外科
6日本医科大学付属病院脳神経外科
7国立精神・神経センター武蔵病院精神神経科
The Role of Pharmaceutical Care in Intractable Epilepsy
Hiroyuki Ura1, 4, Ichiro Takumi2, Osamu Fujino3, Keiko Fukuda4, Shiro Kobayashi5, Daizo Yoshida2, Hiroshi Takahashi2, Akira Teramoto6, Masako Watanabe7 and Kiyomi Sadamoto1
1)Department of Clinical Pathophysiology, Toho University School of Pharmaceutical Sciences
2)Department of Neurosurgery, Nippon Medical School Musashi Kosugi Hospital
3)Department of Pediatrics, Nippon Medical School Chiba Hokuso Hospital
4)Department of Pharmacy, Nippon Medical School Chiba Hokuso Hospital
5)Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital
6)Department of Neurosurgery, Nippon Medical School
7)Department of Psychiatry, National Center of Neurology and Psychiatry
Intractable epilepsy can be divided into the following categories: epilepsy refractory to optimal treatment and epilepsy considered refractory but actually inadequately treated. It is important to assess the individual factors that contribute to making epilepsy refractory, because these factors differ between patients. We report on representative pharmaceutical care, in which a pharmacist assists an epileptologist at an outpatient clinic, to demonstrate the importance of pharmaceutical care in epilepsy treatment. The patient, a 29-year-old woman with a history of forceps delivery, first had a generalized tonic-clonic seizure (GTCS) at the age of 26 years. Several months before this first GTCS, she had had frequent sensory seizures characterized by numbness of the left arm. Magnetic resonance imaging revealed mild atrophy and broad degenerative changes in the white matter. Symptomatic localization-related epilepsy was diagnosed, but we had difficulty administering carbamazepine, zonisamide or valproate because they were poorly tolerated. We started treatment with phenytoin. The GTCSs were not controlled at a serum phenytoin level of 20 μg/mL but were controlled at serum levels of 25 to 30 μg/mL (275 mg/day). However, the patient continued to have sensory seizures twice a month. As a result of consultation between the physician and a pharmacist, gabapentin was also prescribed. Although severe drowsiness developed in the first week after gabapentin was started, the patient could continue treatment by self-tapering the gabapentin dose as the pharmacist had instructed. This pharmaceutical care approach has greatly reduced the frequency of sensory seizures. Thus, it is critically important for pharmacists to administer pharmaceutical care in epilepsy treatment, particularly considering that drug administration is a core element of epilepsy treatment.
日医大医会誌 2010; 6(1), 34-39
Key words
antiepileptic drug, pharmaceutical care, tolerability, intractable epilepsy
Correspondence to
Ichiro Takumi, Department of Neurosurgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki Kanagawa 211-8533, Japan
E-mail：takumi@nms.ac.jp
受付：2009年10月8日 受理：2009年11月13日 |
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