Neurological Involvement in the Course of Scleromyxedema: A Case Report.

Scleromyxedema is a rare disease of unknown etiology primarily affecting the skin, characterized by generalized papular eruption, dermal fibroblast proliferation with mucin deposition, and a monoclonal gammopathy. Neurological impairment is a rare but sometimes fatal complication of scleromyxedema that should be rapidly identified to prevent significant morbidity and mortality. A 63-year-old Caucasian man had a 2-year history of scleromyxedema, and was under immunosuppressive treatment with ciclosporine and methotrexate. The patient came to our attention because of sudden neurological dysfunction with altered sensorium, confusion, and dysarthria. After a few hours since admission, the patient developed left hemiparesis, followed after 2 days by right hemiparesis. The brain computed tomography and cerebrospinal fluid examination results were normal. Brain magnetic resonance imaging (MRI) showed a bilateral cortical hyperintense signal on T2 sequences with leptomeningeal enhancement. Extensive serological and liquoral evaluations were performed without significant findings. After steroid initiation, a remarkable neurological improvement was noticed. The dramatic and immediate response of the patient's to steroid and MRI data strongly suggested a dysimmune etiology. Over the ensuing week, the patient's language, motor, and sensory functions continued to improve. Two weeks after admission, the patient was discharged to home without significant neurological sequelae.

Long-term treatment with oxcarbazepine in clinical practice.

Oxcarbazepine (up to 1800 mg daily orally) was given for 12 months to 61 adult epileptic patients in clinical practice, as monotherapy (n=52) or adjunctive therapy (n=9). Patients on monotherapy became seizure-free (76.9%) or experienced > or = 75% seizure rate reduction, with two exceptions. In the adjunctive therapy group, one patient became seizure-free and two experienced a 50-75% seizure rate reduction. These seizure-free rates are higher than those reported in the literature. The drug was well tolerated; only two patients withdrew because of intolerance (3.3%). Long-term data is essential when evaluating a drug for lifelong treatment. This study contributes to the growing body of 12-month evidence on oxcarbazepine.