(Kiosk 1) Concurrent Encephalopathy and Dysphagia: A Rare Side Effect of Gabapentin

Case Diagnosis: Gabapentin-Induced Encephalopathy with Dysphagia

Case Description: A 61-year-old man with multiple medical comorbidities, including neuropathic pain, was admitted to an inpatient rehabilitation facility (IRF) after a fall that resulted in incomplete paraplegia AIS D. Patient was prescribed gabapentin 100 mg three times a day and gradually increased. Intermittent changes in mental status were noticed during the IRF program, with worsening orientation, attention, visual hallucinations, increased confusion, and progressive dysphagia, which required a strict nothing by mouth (NPO) diet and subsequent enteral nutrition. The patient was transferred back to acute care.

Discussion: The patient underwent a thorough assessment, including electroencephalography (EEG) test, due to suspected encephalopathy. Tests for autoimmune encephalitis serology, meningitis panel, HIV, syphilis, Lyme serologies, and hepatitis panel all returned negative. The patient's gabapentin was discontinued, with improvement in his mental status within 48 hours. He was discharged back to IRF to complete his inpatient rehabilitation course. Upon discharge, the patient resumed a mechanical soft diet with thin liquids.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: The cessation of gabapentin and subsequent resolution of symptoms strongly suggest a drug-induced effect as the cause of acute encephalopathy and dysphagia. Although gabapentin is a commonly used neuropathic agent in spinal cord injury and is generally well-tolerated, there have been rare reports of dysphagia associated with its use. Additionally, encephalopathy has been reported as a rare side effect of Gabapentin.

Conclusion: Gabapentin-induced encephalopathy and dysphagia are significant side effects that can occur together. These side effects are especially important to consider as gabapentin is a common medication in the field of Physical Medicine and Rehabilitation. Physiatrists should be vigilant in recognizing the symptoms early on in order to provide prompt treatment and improve functional outcomes.