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Treatment of drug-induced seizures
#MMPMID26174744
Chen HY
; Albertson TE
; Olson KR
Br J Clin Pharmacol
2016[Mar]; 81
(3
): 412-9
PMID26174744
show ga
Seizures are a common complication of drug intoxication, and up to 9% of status
epilepticus cases are caused by a drug or poison. While the specific drugs
associated with drug-induced seizures may vary by geography and change over time,
common reported causes include antidepressants, stimulants and antihistamines.
Seizures occur generally as a result of inadequate inhibitory influences (e.g.,
gamma aminobutyric acid, GABA) or excessive excitatory stimulation (e.g.
glutamate) although many other neurotransmitters play a role. Most drug-induced
seizures are self-limited. However, status epilepticus occurs in up to 10% of
cases. Prolonged or recurrent seizures can lead to serious complications and
require vigorous supportive care and anticonvulsant drugs. Benzodiazepines are
generally accepted as the first line anticonvulsant therapy for drug-induced
seizures. If benzodiazepines fail to halt seizures promptly, second line drugs
include barbiturates and propofol. If isoniazid poisoning is a possibility,
pyridoxine is given. Continuous infusion of one or more anticonvulsants may be
required in refractory status epilepticus. There is no role for phenytoin in the
treatment of drug-induced seizures. The potential role of ketamine and
levetiracetam is promising but not established.
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