Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis

ABSTRACT

Introduction: Rhabdomyolysis syndrome refers to a variety of factors that affect the striated muscle cell membrane, the membrane channels and its energy supply. Most cases of rhabdomyolysis are due to direct trauma. However, infection, toxins, drugs, muscle ischemia, electrolyte imbalance, metabolic diseases, genetic diseases and abnormal body temperature can also lead to rhabdomyolysis. Epilepsy is one of the most common chronic neurological diseases. The primary long-term treatment is antiepileptic drugs (AEDs), which may cause rhabdomyolysis. This article summarizes the characteristics, treatment methods and prognosis of patients with rhabdomyolysis that is induced by antiepileptic drugs.

Areas covered: This review is based on PubMed, EMBASE and MEDLINE searches of the literature using the keywords “epilepsy”, “antiepileptic drugs”,“status epilepticus”,“rhabdomyolysis”, and “antiepileptic drugs and rhabdomyolysis syndrome” as well as extensive personal clinical experience with various antiepileptic drugs. Potential relationships between antiepileptic drugs and rhabdomyolysis are discussed.

Expert opinion: Worldwide, there are approximately 50 million epilepsy patients, most of whom are treated with drugs. Reports have indicated that the majority of antiepileptic drugs on the market can cause rhabdomyolysis. Although rhabdomyolysis induced by antiepileptic drugs is a rare condition with a low incidence, this condition has serious consequences and merits attention from clinicians.

KEYWORDS:

• antiepileptic drug
• rhabdomyolysis
• creatine kinase
• acute renal failure

Article highlights

• Rhabdomyolysis is a muscle disorder involving the rapid dissolution of skeletal muscle cells.

• The typical symptoms of rhabdomyolysis include acute or subacute myalgia, muscle weakness, and urinary pigmentation, which together are termed the rhabdomyolysis syndrome triad.

• Although antiepileptic drugs have been well studied, the current treatment of epilepsy drugs remains based on the long-term administration of these medications. Given the side effects of various antiepileptic drugs, the improper administration of these medications can seriously affect patients’ quality of life.

• The primary drugs that induce rhabdomyolysis include statins, other lipid-lowering drugs, and psychotropic substances. Rhabdomyolysis caused by antiepileptic drugs has recently become an issue.

• A diagnosis of rhabdomyolysis can be confirmed by examining the causes of a patient’s condition; the patient’s symptoms; and findings from laboratory tests, imaging studies, and muscle biopsies.

• Acute treatment should focus on protecting renal function and correcting the metabolic disorders and acidosis.

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Declaration of Interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.