Byline: Jamir. Rissardo, Ana. Fornari Caprara

Carbamazepine (CBZ) is an anticonvulsant approved for the management of many neurological and psychiatric disorders. We present a case of an adult male with epilepsy who reported new seizures, and the dose of CBZ administered was 1600mg daily. CBZ dose was increased to 1800mg daily. The subject complained of urinary incontinence without dysuria that started after the CBZ dose increase. It was associated with urgency, hesitancy, dribbling of urine, and poor stream. Laboratory tests were within normal limits. He admitted dry mouth, flushing, constipation, and accommodation paralysis starting after CBZ increase. Assuming that these symptoms were an adverse drug reaction, CBZ was withdrawn and valproate was started. The individual had full recovery within four weeks. To the best of our knowledge, only two case reports of similar nature are available, but this is the first one to be reported with young male adult.

Introduction

Carbamazepine (CBZ) is an anticonvulsant approved by the Food and Drug Administration for the management of bipolar type 1 disorder, epilepsy, and trigeminal or glossopharyngeal neuralgia.[1] It is an iminostilbene derivative, of which, the carbamyl group at the first position is responsible for its anti-seizure activity.[1] In this context, CBZ is generally well tolerated with only mild adverse effects. Commonly reported side effects are drowsiness, fatigue, dizziness, nausea, and skin rashes.[1],[2]

Only a few cases of CBZ-associated urinary incontinence have been reported in the literature. To the best of our knowledge, only two case reports of similar nature are available, but this is the first one to be reported with young male adult.[3],[4] To date, urinary incontinence has been associated with other anticonvulsant agents such as valproate, gabapentin, and topiramate.[5],[6],[7]

Here, we report a case of an adult male diagnosed with epilepsy, in which CBZ was increased due to uncontrolled seizures. A week later, the subject complained of urinary symptoms. After a thorough investigation, CBZ was withdrawn, and the symptoms of the individual ameliorated.

Case Report

A 20-year-old man with a two-year history of secondary epilepsy due to a traumatic brain injury was seizure free. He was in use of CBZ (1600mg a day). But during a routine visit in our neurology department, the subject reported new seizures that started within the last four months. The ictal episodes were of focal onset with impaired awareness. An electroencephalogram showed left temporal spike waves with typical phase inversion. The neurological exam was normal. Laboratory tests were within normal limits. CBZ dose was increased.

After two weeks, he was in use of CBZ (200mg, three capsules) three times a day. However, the subject complained of urinary incontinence without dysuria that started seven days after the CBZ dose was increased. It was associated with...