vfumedВестник Северо-Восточного федерального университета имени М.К. Аммосова. Vestnik of North-Eastern Federal University. Серия «Медицинские науки. Medical Sciences»Vestnik of North-Eastern Federal University. Medical Sciences2587-5590Северо-Восточный федеральный университет имени М.К. Аммосоваvfumed-294Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEФАРМАКОГЕНЕТИЧЕСКИЕ ФАКТОРЫ РАЗВИТИЯ ПОВЕДЕНЧЕСКИХ НЕЖЕЛАТЕЛЬНЫХ РЕАКЦИЙ НА ФОНЕ ПРИЕМА ПРОТИВОЭПИЛЕПТИЧЕСКИХ ПРЕПАРАТОВ (КЛИНИЧЕСКИЙ СЛУЧАЙ)PHARMACOGENETIC FACTORS IN THE DEVELOPMENT OF BEHAVIORAL ADVERSE REACTIONS WHILE TAKING ANTIEPILEPTIC DRUGS: A CLINICAL CASEУсольцеваА. А.UsoltsevaA. A.

УСОЛЬЦЕВА Анна Александровна – аспирант кафедры медицинской генетики и клинической нейрофизиологии ИПО

Красноярск

тел. 89029721964

USOLTSEVA Anna Alexandrovna – postgraduate student, Department of Medical Genetics and Clinical Neurophysiology, Institute of Postgraduate Education

Krasnoyarsk

a.usoltseva@list.ruКривцоваЕ. Р.KrivcovaE. R.

КРИВЦОВА Екатерина Романовна – студент

Красноярск

тел. 8908214226

KRIVCOVA Ekaterina Romanovna – student

Krasnoyarsk

ekrivcova001@gmail.comДмитренкоД. В.DmitrenkoD. V.

ДМИТРЕНКО Диана Викторовна – д.м.н., заведующая кафедрой медицинской генетики и клинической нейрофизиологии ИПО

Красноярск

тел. 89080160312

 

DMITRENKO Diana Victorovna – Dr. Sci. (Medicine), Chief of Chair of Medical Genetics and Clinical Neurophysiology, Institute of Postgraduate Education, Head of Laboratory of Medical Genetics, Head of Neurological Center, University Clinic

Krasnoyarsk

mart2802@yandex.ruФГБОУ ВО КрасГМУ им. проф. В.Ф.Войно-Ясенецкого Минздрава РоссииРоссияV.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of the RFRussian Federation202409102024035865Copyright © Усольцева А.А., Кривцова Е.Р., Дмитренко Д.В., 20242024Усольцева А.А., Кривцова Е.Р., Дмитренко Д.В.Usoltseva A.A., Krivcova E.R., Dmitrenko D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.smnsvfu.ru/jour/article/view/294

По данным различных исследований на сегодняшний день частота различных нежелательных реакций может достигать 50 %. Психиатрические и поведенческие реакции, в частности агрессия, являются наиболее распространенными, с ними сталкиваются до 20-30 % пациентов, использующих противоэпилептические препараты. Мы предлагаем клиническое наблюдение за пациентом со структурной эпилепсией, у которого на фоне стартового введения леветирацетама развились поведенческие нежелательные реакции (агрессия, раздражительность, импульсивность), в связи, с чем было проведено нейропсихологическое и фармакогенетичекое тестирование. По данным фармакогенетического исследования, выявлено носительство однонуклеотидных вариантов генов, предрасполагающих к изменениям в обмене дофамина и серотонина, что увеличивает риск агрессивного поведения, включая ауто- и внешнюю агрессию, в том числе на фоне приёма стартовой дозы леветирацетама. С учётом клинической картины и специализированного дообследовнаия проведена коррекция терапии, включающая отмену леветирацетама, что позволило купировать нежелательные реакции. Данный клинический случай демонстрирует важность персонализированного фармакогенетического исследования у пациентов с эпилепсией, что позволяет проводить эффективную и безопасную терапию. Это позволяет значимо улучшить качество жизни пациентов.

According to various studies, to date the frequency of various adverse reactions can reach 50 %.

Psychiatric and behavioral reactions, in particular aggression, are the most common, occurring in up to 20-30 % of patients using antiepileptic drugs. We offer clinical observation of a patient with structural epilepsy, who developed behavioral adverse reactions (aggression, irritability, impulsivity) during the initial administration of Levetiracetam, and therefore neuropsychological and pharmacogenetic testing was carried out. According to a pharmacogenetic study, carriage of single-nucleotide variants of genes was identified that predispose to changes in the metabolism of dopamine and serotonin, which increases the risk of aggressive behavior, including auto- and external aggression, also while taking a starting dose of Levetiracetam. Taking into account the clinical picture and specialized additional examination, the therapy was adjusted, including the abolition of Levetiracetam, which made it possible to stop unwanted reactions. This clinical case demonstrates the importance of personalized pharmacogenetic research in patients with epilepsy, which ensures more effective and safe therapy. This can significantly improve the quality of life of patients.

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The authors declare that there are no conflicts of interest present.