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Cases reported "Epilepsy, Tonic-Clonic"
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1/59. hypersensitivity reaction in a child due to lamotrigine.Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the united states for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.- - - - - - - - - - ranking = 1keywords = action (Clic here for more details about this article) |
2/59. Cross-sensitivity and the anticonvulsant hypersensitivity syndrome.The anticonvulsant hypersensitivity syndrome is a rare complication that occurs with the use of antiepileptic medications. Although phenytoin is the most common culprit, carbamazepine and phenobarbital are known to cause a similar reaction. A familial occurrence has been reported. We present a case of the anticonvulsant hypersensitivity syndrome to emphasize the importance of recognizing the multiple clinical components of the syndrome and to raise awareness of the cross-sensitivity among anticonvulsants metabolized via arene oxide metabolites.- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
3/59. cyclopentolate and grand mal seizure.The author describes a case of grand mal seizures that occurred on two occasions after ocular instillation of cyclopentolate 2% for refraction in a 11-year old epileptic girl. The first and the second crisis developed respectively 45 and 30 minutes after instillation of the drug. cyclopentolate should be contraindicated in known epileptic children.- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
4/59. Successful treatment of normeperidine neurotoxicity by hemodialysis.Normeperidine, a major metabolite of meperidine, is half as potent as meperidine as an analgesic but two to three times more potent as a convulsant. Renal failure significantly increases the plasma half-life of normeperidine. The intensity of the central nervous system excitation is highly correlated with the plasma concentration of normeperidine. Moreover, normeperidine toxicity is not reversed by naloxone, which may exacerbate it. We report a patient with end-stage renal disease undergoing maintenance continuous cycler peritoneal dialysis who had been receiving meperidine for pain control. The patient subsequently developed myoclonic contractions and a grand mal seizure. The patient was successfully treated with hemodialysis (using an F8 dialyzer) for presumed normeperidine-induced seizure. During hemodialysis, normeperidine average blood clearance was 73 mL/min, average plasma clearance was 50 mL/min, and average percentage of plasma extraction was 24%. There also was a 26% reduction in plasma concentration of normeperidine over 3 hours of hemodialysis. In conclusion, our findings suggest that hemodialysis may be used effectively for treating patients with suspected normeperidine-induced neurotoxicity.- - - - - - - - - - ranking = 0.4keywords = action (Clic here for more details about this article) |
5/59. Nonconvulsive status epilepticus resulting from Jarisch-Herxheimer reaction in a patient with neurosyphilis.We report a case of Jarisch-Herxheimer reaction in a patient with neurosyphilis, which was complicated by nonconvulsive status epilepticus. The EEG features suggested a focal seizure onset, although the patient's MRI was normal. JHR is common in the treatment of neurosyphilis, but usually produces only transient systemic constitutional symptoms. Neurologic deterioration is rare, but can be dramatic, as in our patient. NCSE should be considered as an explanation for persistent obtundation and transient focal neurologic findings in this setting.- - - - - - - - - - ranking = 1keywords = action (Clic here for more details about this article) |
6/59. Severe neurotoxic reaction associated with oral ingestion of low-dose diethyltoluamide-containing insect repellent in a child.N,N-Diethyl-m-toluamide (deet) is the major component of almost all tick repellent products. Reports of severe adverse reactions following voluntary ingestion are rare and primarily involve adults. This report describes a case of a toxic reaction after ingestion of low doses (80 mg/kg) of deet in a child. The signs and symptoms were coma and seizures within 2 hours of ingestion. The patient recovered without sequelae. It is concluded that even scant doses of deet may provoke severe encephalopathy in small children, and caution should be used when leaving this chemical unattended.- - - - - - - - - - ranking = 1.2keywords = action (Clic here for more details about this article) |
7/59. seizures during lithium-amitriptyline therapy.Epileptiform seizures occurred in a 34-year-old woman who was receiving amitriptyline and lithium carbonate therapy for treatment of endogenous depression. While receiving amitriptyline maintenance therapy, she was given lithium on two separate occasions, and despite serum levels of lithium in the therapeutic range, grand mal seizures developed. The seizures may represent a toxic reaction either to lithium or to combined drug therapy. Controlled studies are needed to evaluate both the efficacy and toxicity of combined drug therapy in affective disorders.- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
8/59. pseudohypoparathyroidism type IA and II with severe neuropsychic manifestations.pseudohypoparathyroidism (PHP) is characterized by unresponsiveness of target tissues to the biological actions of the parathyroid hormone (PTH), with resulting hypocalcemia and hyperphosphatemia, despite the elevated serum levels of PTH. PHP is divided into types Ia, b, c and II, depending on the presence of Albright's hereditary osteodystrophy (AHO), defective urinary excretion of phosphate (U-P) and response in urinary excretion of cyclic adenosine monophosphate (U-cAMP) after the administration of exogenous PTH. patients with PHP might exhibit various manifestations of neuropsychic disturbances. We present two boys, aged 14 and 16 years, both with paresthesia, anxiety and epilepsy; the former patient also suffered from mild mental retardation. In both patients, hypocalcemia and hyperphosphatemia together with increased serum levels of PTH suggested the diagnosis of PHP. After administration of exogenous PTH (Ellsworth-Howard test), there was a drop in U-P in both patients, while U-cAMP was decreased in the first patient and increased in the second one, thus confirming the diagnoses of PHP Ia and II, respectively. Neuropsychic disturbances and epilepsy resolved completely in both patients after treatment with calcium and dihydrotachysterol. Evaluation of calcemia and phosphatemia should be mandatory in all patients with neuropsychic disorders. Ellsworth-Howard test remains a useful tool in the differential diagnosis of PHP.- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
9/59. Generalized tonic-clonic activity after remifentanil administration.IMPLICATIONS: This is the first report of seizure-like activity in an adult who received remifentanil. This report confirms that opioid administration can be associated with generalized tonic-clonic seizure-like activity. It is suggested that this reaction could be referred to as the "opioid-seizure syndrome."- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
10/59. Is there scope for checking serum biochemistry in the epilepsy clinic?We often request blood investigations, almost as a knee-jerk reaction, without asking ourselves why and what we expect to exclude or confirm by doing the test. We often fail to put the patients presentation into clinical perspective. Here, we present a scenario where routine blood tests were unexpectedly abnormal. A patient presents to the First Fit clinic, having sustained two generalised tonic-clonic epileptic seizures. She was commenced on anti-epileptic medication by her GP prior to being seen by the neurologists. Routine blood investigations taken in the clinic revealed significant hypocalcaemia. She was investigated for the cause of this biochemical derangement and started on 1-alphahydroxycholecaliferol. Her antiepileptic drug was discontinued once her serum calcium was corrected since she was considered to have symptomatic seizures. The discussion deals with the causes of hypocalcaemia, which is less commonly encountered than hypercalcaemia, and the relevance of checking a patients biochemistry in the First Fit clinic. In view of the latter point, there is no clear answer and its use fails to be justified by any strong evidence.- - - - - - - - - - ranking = 0.2keywords = action (Clic here for more details about this article) |
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