Risk factors for complications of drug-induced seizures

Josef G Thundiyil, Freda Rowley, Linda Papa, Kent R Olson, Thomas E Kearney, Josef G Thundiyil, Freda Rowley, Linda Papa, Kent R Olson, Thomas E Kearney

Abstract

The purpose of this study is to determine clinical factors associated with complications of drug-induced seizures. This prospective observational study was conducted at an American Association of Poison Control Centers-certified regional poison control center (PCC) over a 1-year period. All consecutive cases reported to a PCC involving seizures were forwarded to investigators, who obtained standardized information including the specific drug or medication exposure, dose, reason for exposure, vital signs, laboratory data, treatment, and outcome. Patients were monitored by daily telephone follow-up until death or discharge. Subjects were excluded if the seizure was deemed to be unrelated to exposure. Odds ratios were used to analyze variables for associations with admission to the hospital for >72 h, endotracheal intubation, status epilepticus, anoxic brain injury, or death. One hundred twenty-one cases met inclusion criteria. Sixty-three (52%) were male, and the mean age was 30 (SD14) years. Common exposures included: antidepressants (33%), stimulants (15%), and anticholinergics (10%). One hundred and three (85%) of the exposures were intentional, of which 74 were suicide attempts and 16 were drug abuse or misuse. Forty-nine (40%) patients required endotracheal intubation, 12(10%) had status epilepticus, 50(41%) were hospitalized for more than 72 h, and one patient died. Median hospital stay was 3 days. Variables significantly associated with complications included stimulant exposure (odds ratios, OR=11 [95% confidence intervals (CI) 1.9-52]), suicide attempt (OR=2.2 [95% CI 1.02-4.7]), initial hypotension (OR=11.2 [95% CI 1.4-89.3]), admission glucose >130 mg/dL (OR=5.4 [95% CI 1.6-18.1]), and admission HCO(3) <20 mEq/L (OR=4.0 [95% CI 1.4-11.3]). Significant clinical factors associated with complications of drug-related seizures include stimulant exposure, suicide attempt, initial hypotension, and admission acidosis or hyperglycemia.

© The Author(s) 2010. This article is published with open access at Springerlink.com

Figures

Fig. 1
Fig. 1
Breakdown of study patients with complications. LOS length of stay, ETT endotracheally intubated, SE status epilepticus, ABI anoxic brain injury
Fig. 2
Fig. 2
Results of logistic regression model for complicated hospital course

References

    1. Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia. 1975;16(1):1–66. doi: 10.1111/j.1528-1157.1975.tb04721.x.
    1. ACEP Clinical Policies Committee. Clinical Policies Subcommittee on Seizures Clinical policy: critical issues in the evaluation and management of adult patients presenting the emergency department with seizures. Ann Emerg Med. 2004;43(5):605–625. doi: 10.1016/j.annemergmed.2004.01.017.
    1. Isbister GK, Downes F, Sibbritt D, et al. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med. 2004;32(1):88–93. doi: 10.1097/01.CCM.0000104207.42729.E4.
    1. Thundiyil JG, Kearney TE, Olson KR. The evolving epidemiology of drug induced seizures reported to a poison control center system. J Med Toxicol. 2007;3(1):15–19. doi: 10.1007/BF03161033.
    1. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–1035.
    1. Pesola GR, Avasarala Bupropion seizure proportion amon new-onset generalized seizures and drug related seizures presenting to an emergency department. J Emerg Med. 2002;22(3):235–239. doi: 10.1016/S0736-4679(01)00474-7.
    1. Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia. 1993;34(6):1033–1037. doi: 10.1111/j.1528-1157.1993.tb02130.x.
    1. Alldredge BK, Lowenstein DH, Simon RP. Seizures associated recreational drug abuse. Neurology. 1989;39(8):1037–1039.
    1. Towne AR, Pellock JM, Ko D, et al. Determinants of mortality in status epilepticus. Epilepsia. 1994;35(1):27–34. doi: 10.1111/j.1528-1157.1994.tb02908.x.
    1. Sagduyu A, Tarlaci S, Sirin H. Generalized tonic–clonic status epilepticus: causes, treatment, complications, and predictors of case fatality. J Neurol. 1998;245(10):640–646. doi: 10.1007/s004150050260.
    1. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–245. doi: 10.1038/clpt.1981.154.
    1. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, et al. A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med. 1998;339:792–798. doi: 10.1056/NEJM199809173391202.
    1. Koubeissi M, Alshekhlee A. In-hospital mortality of generalized convulsive status epilepticus: a large US sample. Neurology. 2007;69(9):886–893. doi: 10.1212/01.wnl.0000269791.96189.70.
    1. Huff JS, Morris DL, Kothari RU, et al. Emergency department management of patients with seizures: a multicenter study. Acad Emerg Med. 2001;8(6):622–628. doi: 10.1111/j.1553-2712.2001.tb00175.x.
    1. Drug Abuse Warning Network (2004) Area profiles of drug-related mortality. DAWN Series D-31, DHHS Publication No. (SMA) 08-4346, Rockville, MD, 2008. Available at: . Accessed January 10, 2009.
    1. Huang CW, Tsai JJ, Ou HY, et al. Diabetic hyperglycemia is associated with severity of epileptic seizures in adults. Epilepsy Res. 2008;79(1):71–77. doi: 10.1016/j.eplepsyres.2007.12.012.
    1. Rathakrishnan R, Sidik NP, Huak CY, et al. Generalised convulsive status epilepticus in Singapore: clinical outcomes and potential prognostic markers. Seizure. 2009;18(3):202–205. doi: 10.1016/j.seizure.2008.09.005.
    1. Huang CW, Cheng JT, Tsai JJ, et al. Diabetic hyperglycemia aggravates seizures and status epilepticus-induced hippocampal damage. Neurotox Res. 2009;15(1):71–81. doi: 10.1007/s12640-009-9008-2.
    1. Suh SW, Shin BS, Van Hoecke M, et al. Glucose and NADPH oxidase drive neuronal superoxide formation in stroke. Ann Neurol. 2008;64(6):654–663. doi: 10.1002/ana.21511.
    1. Cherian L, Hannay HJ, Vagner G, et al. Hyperglycemia increases neurological damage and behavioral deficits from post-traumatic secondary ischemic insults. J Neurotrauma. 1998;15(5):307–321. doi: 10.1089/neu.1998.15.307.
    1. Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426–2432. doi: 10.1161/hs1001.096194.
    1. Li PA, Shuaib A, Miyashita H, et al. Hyperglycemia enhances extracellular glutamate accumulation in rats subjected to forebrain ischemia. Stroke. 2000;31(1):183–192.
    1. Nedergaard M, Goldman SA, Desai S, et al. Acid-induced death in neurons and glia. J Neurosci. 1991;11(8):2489–2497.
    1. Hoxworth JM, Xu K, Zhou Y, et al. Cerebral metabolic profile, selective neuron loss, and survival of acute and chronic hyperglycemic rats following cardiac arrest and resuscitation. Brain Res. 1999;821(2):467–479. doi: 10.1016/S0006-8993(98)01332-8.
    1. Rehncrona S. Brain acidosis. Ann Emerg Med. 1985;14(8):770–776. doi: 10.1016/S0196-0644(85)80055-X.
    1. Lundgren J, Smith ML, Blennow G, et al. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Resuscitation. 1994;99(1):43–55.
    1. Yager JY, Armstong EA, Jaharus C, et al. Preventing hyperthermia decreases brain damage following neonatal hypoxic-ischemic seizures. Brain Resuscitation. 2004;1011(1):48–57. doi: 10.1016/j.brainres.2004.02.070.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner