临床上许多抗生素加重癫痫患者的临床发作或者诱发非癫痫患者产生癫痫。这些常见的药物包括盘尼西林和内酰胺类抗生素，亚胺培南-西司他丁和喹诺酮类抗生素1。诱发癫痫的机制包括抗生素影响神经递质从而降低了癫痫阈值或者是抗生素降低了抗癫痫药物的抗癫痫效能2,3。
利奈唑胺是恶唑烷酮类新型抗生素中第一种药物。恶唑烷酮类抑制蛋白合成，主要作用于革兰氏阳性细菌。利奈唑胺最常见的药物副反应包括恶心，头痛和腹泻4。严重副作用如可逆性骨髓抑制已有报道4,5。利奈唑胺在与五羟色胺能的药物合用时会增加五羟色胺综合征（血清素综合症）的发生风险4,6。在儿童药品说明书中，癫痫已列为利奈唑胺的副作用4；但是，无医学相关文献报道利奈唑胺诱发癫痫的病例。我们报道一例既往具有癫痫的患者在接受利奈唑胺治疗时出现了复杂部分性发作持续状态（complex partial status epilepticus, CPSE）。
2008年04月10日，患者因右膝痛性疣样生长物接受了切除手术。她的伤口愈合不良，疑似感染。4月22日创口菌培养结果符合非致病性皮肤菌群。4月24日患者接受了伤口清创术，同时给予万古霉素治疗，4月25日换成利奈唑胺，给予一次剂量。4月26日，患者出院回家，口服利奈唑胺，服用了两个剂量的利奈唑胺。当天晚上，患者平时出现的复杂部分发作变得发作频繁，且发作时间延长。口服劳拉西泮不能控制。癫痫发作几乎持续不断，患者被送到OSU医学中心，诊断为复杂部分发作持续状态，予以气管插管，静点丙泊酚，在她常用的抗癫痫药物的基础上加用了静脉左乙拉西坦治疗，开始静脉注射万古霉素替代利奈唑胺。持续脑电图监测显示最初的左侧额中央区频繁痫性波发放在用药治疗后逐渐恢复。4月28日早晨丙泊酚停用，患者成功脱机拔管。她的癫痫恢复到原先的状态（每日发作少许几次）。患者的检查结果排除了任何急性系统性的或神经系统的疾病。她起初有发热，可是没有找到感染源的证据。4月29日，所有的静脉用药替换为口服用药，计划抗生素使用疗程为7天。4月30日，患者再次口服利奈唑胺，上午患者开始出现长时程频发癫痫。给予苯二氮卓类药物治疗并增加左乙拉西坦剂量。但是，她的癫痫发作更加频繁。5月1日早晨总共用了三个剂量的利奈唑胺后停用了利奈唑胺这个药物。在接下来的18个小时内，患者的癫痫次数戏剧性好转几乎恢复到了原来的状态。次日（5月2日）患者出院回家了。
此例病人出现CPSE和癫痫状况加重，该患者没有急性神经系统或者全身性的疾病可以解释她的癫痫加重原因。患者既往的病史中未出现过癫痫持续状态，且她是依从性很好的患者。虽然我们不能确定癫痫加重的准确原因，但从时间发生的相关性看，利奈唑胺是其原因。患者两次分别使用了利奈唑胺，每次使用利奈唑胺不超过24小时，癫痫发作都显著恶化，在停用利奈唑胺24小时内癫痫显著改善。
利奈唑胺加重此患者癫痫的机制尚不清楚。该患者的合并用药清单没有显示任何可能与利奈唑胺发生药物之间相互作用的药物。遗憾的是没有检测唑尼沙胺或者氯硝西泮的血药浓度，不能确定利奈唑胺对二者血药浓度有没有影响。总之，利奈唑胺谨慎用于有癫痫病史的患者。
中英 对照部分
Neurology 72 January 27,2009
Bassel F. Shneker, MD Peggy D. Baylin, PharmD Michael E. Nakhla, PharmD
Many antibiotics can worsen seizures in patients with epilepsy and provoke seizures in patients without epilepsy. The agents most commonly associated with this adverse effect include penicillin and other ß -lactams, imipenem-cilastatin, and quinolones.1 The mechanism by which antibiotics can induce seizures can be related to lowering seizure threshold by affecting neurotransmitters or by decreasing the efficacy of antiepileptic drugs (AEDs).2,3
临床上许多抗生素加重癫痫患者的临床发作或者诱发非癫痫患者产生癫痫。这些常见的药物包括盘尼西林和内酰胺类抗生素，亚胺培南-西司他丁和喹诺酮类抗生素1。诱发癫痫的机制包括抗生素影响神经递质从而降低了癫痫阈值或者是抗生素降低了抗癫痫药物的抗癫痫效能2,3。
Linezolid (Zyvox) is the first agent in a new class of antibiotics known as oxazolidinones. Oxazolidinones act primarily against Gram-positive bacteria by inhibiting protein synthesis. The most common side effects from linezolid are nausea, headache, and diarrhea.4 Serious adverse effects such as reversible myelosuppression have been reported.4,5 Linezolid may increase the risk of serotonin syndrome when taken with other serotonergic agents.4,6 Seizures have been reported as side effects in the package insert in children4;however,no case reports of linezolid-induced seizures exist in the medical literature. We report a patient with epilepsy who experienced complex partial status epilepticus(CPSE) upon receiving linezolid.
利奈唑胺是恶唑烷酮类新型抗生素中第一种药物。恶唑烷酮类抑制蛋白合成，主要作用于革兰氏阳性细菌。利奈唑胺最常见的药物副反应包括恶心，头痛和腹泻4。严重副作用如可逆性骨髓抑制已有报道4,5。利奈唑胺在与五羟色胺能的药物合用时会增加五羟色胺综合征（血清素综合症）的发生风险4,6。在儿童药品说明书中，癫痫已列为利奈唑胺的副作用4；但是，无医学相关文献报道利奈唑胺诱发癫痫的病例。我们报道一例既往具有癫痫的患者在接受利奈唑胺治疗时出现了复杂部分性发作持续状态（complex partial status epilepticus, CPSE）。
The patient is a 45-year-old lefthanded woman with a history of epilepsy since childhood. She has been followed in the Epilepsy Clini cat The Ohio State University (OSU) for more than 10 years. She has rare tonic-clonic seizures, frequent (3 per day) simple partial (right-sided dystonic posture for a few seconds), and frequent (2 per day) complex partial seizures (extension of both legs and clonic movements of right side lasting for less than a minute). Her seizures have been intractable despite trying all approved AEDs, vagus nerve stimulator, and two resective brain surgeries (left frontal lobe) that resulted in right-sided weakness. Her past medicalcal history is significant for postictal psychosis and depression. Her medications included zonisamide, clonazepam, acetazolamide, aripiprazole, and lorazepam as needed. She had no history of unusual reaction to any medication.
患者为45岁女性，左利手，从年幼时即有癫痫发作病史。她在俄亥俄洲立大学的癫痫门诊随诊10余年。她极少出现强直-阵挛性癫痫发作，而是频发简单部分性发作（约每日三次，右侧肌张力障碍姿势数秒钟），频发复杂部分性发作（约每日两次，双腿伸展和右侧阵挛性运动持续不到1分钟）。尽管尝试了所有获准的抗癫痫药，但患者已成为难治性癫痫。迷走神经刺激器和两次脑组织切除手术（左侧额叶）后导致右侧肢体无力。在既往病史中有意义的是发作后精神症状和抑郁。患者治疗药物包括唑尼沙胺，氯硝西泮，乙酰唑胺，阿立哌唑和必要时加用劳拉西泮。无任何药物异常反应史。
On April 10, 2008, she underwent an excision of a painful wart-like growth on her right knee. Her wound did not heal well and a wound infection was suspected. Wound cultures on April 22, 2008, were consistent with nonpathologic skin flora. On April 24, 2008, she underwent debridement of her wound and was placed on IV vancomycin, then switched to IV linezolid on April 25, 2008, receiving one dose. She was discharged home on April 26, 2008, on oral linezolid. Two doses were taken. In the evening of April 26, 2008, her habitual complex partial seizures became more frequent and longer in duration. Oral lorazepam did not help. The seizures became almost constant. She was admitted to OSU Medical Center with a diagnosis of CPSE. She was intubated, placed on a propofol drip, and given IV levetiracetam in addition to her home AEDs. IV vancomycin was started in place of linezolid. Continuous EEG monitoring showed initially frequent seizures of left fronto-central onset that subsided with treatment. On the morning of April 28, 2008, propofol was stopped and she was successfully extubated. Her seizures were back to baseline (few daily seizures). Her workup ruled out any acute systemic or neurologic process. She was febrile at presentation; however, no source of infection was found. On April 29,2008, all IV medications were switched to oral formulations with plans to complete a 7-day course of antibiotics. Oral linezolid was restarted on April 30, 2008. Late that morning, she started to have prolonged and frequent seizures. She received benzodiazepines and her levetiracetam was increased. Seizures became more frequent. On the morning of May 1, 2008, linezolid was stopped after a total of three doses. She was loaded with IV fosphenytoin. Within 18 hours, the patient’s seizure frequency improved dramatically and she seemed to be at her baseline. She was discharged home on May 2, 2008.
2008年04月10日，患者因右膝痛性疣样生长物接受了切除手术。她的伤口愈合不良，疑似感染。4月22日创口菌培养结果符合非致病性皮肤菌群。4月24日患者接受了伤口清创术，同时给予万古霉素治疗，4月25日换成利奈唑胺，给予一次剂量。4月26日，患者出院回家，口服利奈唑胺，服用了两个剂量的利奈唑胺。当天晚上，患者平时出现的复杂部分发作变得发作频繁，且发作时间延长。口服劳拉西泮不能控制。癫痫发作几乎持续不断，患者被送到OSU医学中心，诊断为复杂部分发作持续状态，予以气管插管，静点丙泊酚，在她常用的抗癫痫药物的基础上加用了静脉左乙拉西坦治疗，开始静脉注射万古霉素替代利奈唑胺。持续脑电图监测显示最初的左侧额中央区频繁痫性波发放在用药治疗后逐渐恢复。4月28日早晨丙泊酚停用，患者成功脱机拔管。她的癫痫恢复到原先的状态（每日发作少许几次）。患者的检查结果排除了任何急性系统性的或神经系统的疾病。她起初有发热，可是没有找到感染源的证据。4月29日，所有的静脉用药替换为口服用药，计划抗生素使用疗程为7天。4月30日，患者再次口服利奈唑胺，上午患者开始出现长时程频发癫痫。给予苯二氮卓类药物治疗并增加左乙拉西坦剂量。但是，她的癫痫发作更加频繁。5月1日早晨总共用了三个剂量的利奈唑胺后停用了利奈唑胺这个药物。在接下来的18个小时内，患者的癫痫次数戏剧性好转几乎恢复到了原来的状态。次日（5月2日）患者出院回家了。
Our patient developed CPSE and had worsening of her seizures. The patient had no acute neurologic or systemic illness to explain the worsening of her seizures. She has no history of status epilepticus in the past. Historically, she is a very compliant patient. Although we cannot be definite about the exact cause, the chronological correlation suggests that linezolid was the cause. Our patient was given linezolid on two separate occasions. On each occasion, within less than 24 hours of starting linezolid, she had significant worsening of her seizures. Seizures improved dramatically within 24 hours of stopping linezolid.
此例病人出现CPSE和癫痫状况加重，该患者没有急性神经系统或者全身性的疾病可以解释她的癫痫加重原因。患者既往的病史中未出现过癫痫持续状态，且她是依从性很好的患者。虽然我们不能确定癫痫加重的准确原因，但从时间发生的相关性看，利奈唑胺是其原因。患者两次分别使用了利奈唑胺，每次使用利奈唑胺不超过24小时，癫痫发作都显著恶化，在停用利奈唑胺24小时内癫痫显著改善。
The mechanism by which linezolid worsened our patient’s seizures is not clear. A review of thepatient’s concomitant medication list did not reveal any possible drug–drug interactions with linezolid. Unfortunately, the levels of zonisamide and clonazepam were not checked to determine if linezolid affected either one. Linezolid should be administered cautiously in patients with a history of epilepsy.
利奈唑胺加重此患者癫痫的机制尚不清楚。该患者的合并用药清单没有显示任何可能与利奈唑胺发生药物之间相互作用的药物。遗憾的是没有检测唑尼沙胺或者氯硝西泮的血药浓度，不能确定利奈唑胺对二者血药浓度有没有影响。总之，利奈唑胺谨慎用于有癫痫病史的患者。
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