1/21. Acute intoxication with sodium valproate.Two epileptic patients developed an acute toxic encephalopathy consisting of altered behavior, deteriorating seizure control, and confusion while taking sodium valproate alone. serum valproate levels were greater than 100 microgram/ml in both. Toxic symptoms resolved when the dose of valproate was reduced, with a consequent fall in serum concentration of the drug.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/21. Interaction of topiramate with carbamazepine: two case reports and a review of clinical experience.We describe a possible clinical interaction between topiramate (TPM) and carbamazepine modified release (CBZ-MR) in patients taking maximum tolerated doses of carbamazepine. Data are presented on 25 patients who contacted the epilepsy nurse specialist telephone helpline for advice after starting treatment with TPM. Thirteen male and 12 female patients, mean age 41 years (range 25-69 years), with localization-related epilepsy contacted the helplines, between November 1999 and March 2001, complaining of symptoms of antiepileptic drug intoxication after starting treatment with TPM. All were taking maximum tolerated doses of CBZ-MR before starting TPM. Sixteen of the patients were taking other antiepileptic drugs concomitantly with CBZ-MR and TPM. Symptoms of intoxication were similar to those previously experienced when maximum tolerated doses of CBZ-MR were exceeded. Symptoms resolved when concomitant CBZ-MR doses were reduced, enabling further dose escalation of TPM. To our knowledge, neither clinical nor pharmacological interactions between CBZ and TPM have been described previously in man. These data suggest that such an interaction may be of clinical importance, and that reduction of the CBZ dose may enable optimization of the dose of TPM, improving seizure control.- - - - - - - - - - ranking = 0.5keywords = intoxication (Clic here for more details about this article) |
3/21. Three cases of recurrent epileptic seizures caused by endosulfan.To commit suicide, three young adults swallowed a relatively small amount of a widely used insecticide containing endosulfan. They developed recurrent epileptic seizures. After hospitalization they were treated and recovered without any sequel. These seizures were classified as acute symptomatic or provoked seizures. We suggest that if one faces acute repetitive seizures, especially in the rural areas, an intoxication such as endosulfan intoxication should be considered when the etiology is uncertain even in the absence of any signs of intoxication.- - - - - - - - - - ranking = 0.75keywords = intoxication (Clic here for more details about this article) |
4/21. manganese intoxication: the cause of an inexplicable epileptic syndrome in a 3 year old child.Excess manganese (Mn) can cause several neurotoxic effects, however only a few studies have reported epileptic syndromes related to manganese intoxication. We describe an epileptic syndrome due to manganese intoxication in a 3 year old male child. His blood manganese was elevated, but no other abnormal values or toxic substances were found in blood or urine. The electroencephalogram (EEG) showed a picture of progressive encephalopathy, while brain magnetic resonance was normal. The patient's conditions rapidly worsened to epileptic status despite the use of antiepileptic drugs. Chelating treatment with CaNa(2)EDTA was initiated to remove excess manganese and promptly succeeded in reverting epileptic symptoms. Concurrently, manganese blood levels and electroencephalogram progressively normalized. Thereafter it has been possible to discontinue antiepileptic treatment, and the patient remains in excellent conditions without any treatment.- - - - - - - - - - ranking = 1.5keywords = intoxication (Clic here for more details about this article) |
5/21. hair analysis differentiates chronic from acute carbamazepine intoxication.This is a report of a 12-year-old epileptic child undergoing chronic treatment with carbamazepine who was found comatose. He was considered to have acute severe drug toxicity. Measurement of carbamazepine concentration in the patient's hair segments together with the carbamazepine blood levels were both important in determining the chronic nature of the patient's intoxication.- - - - - - - - - - ranking = 1.25keywords = intoxication (Clic here for more details about this article) |
6/21. valproic acid intoxication: sense and non-sense of haemodialysis.INTRODUCTION: valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. We describe two case reports involving valproic acid intoxication with ingestion of ethanol. methods: One patient was treated by supportive care, one patient received haemodialysis. RESULTS: From analysis of plasma concentrations before and during haemodialysis (pre- and post-filter) it is shown that valproic acid can be effectively eliminated by haemodialysis when plasma levels are way above 100 microg/ml. In the literature, plasma protein binding is reported to be around 90% for levels within the therapeutic range. In our patient plasma protein binding was around 50% after treatment with haemodialysis. CONCLUSION: These findings make haemodialysis in valproic acid intoxication a sensible therapeutic option with increasing efficiency when plasma concentration is high. Furthermore our findings suggest that lowering valproic acid concentrations to a therapeutic level by haemodialysis does not necessarily result in an immediate, simultaneous increase in plasma protein binding of valproic acid.- - - - - - - - - - ranking = 1.5keywords = intoxication (Clic here for more details about this article) |
7/21. Benign angiopathy of the central nervous system associated with phenytoin intoxication.We report a patient with epilepsy who presented with acute onset of left hemiparesis associated with phenytoin intoxication due to interaction with clobazam. magnetic resonance angiography of the head revealed stenosis of the M2 segment of the right middle cerebral artery, whereas an erythrocyte sedimentation rate and cerebrospinal fluid analysis were normal, being consistent with a diagnosis of benign angiopathy of the central nervous system. The patient exhibited an elevated plasma level of thrombin-antithrombin iii complex along with a marginally increased plasma concentration of soluble e-selectin. The present case suggests that phenytoin intoxication can cause cerebral vasospasm, which may be associated with some inflammatory endothelial injury accompanied by activated intravascular coagulation.- - - - - - - - - - ranking = 1.5keywords = intoxication (Clic here for more details about this article) |
8/21. phenytoin-induced seizures: a paradoxical effect at toxic concentrations in epileptic patients.We examined the incompletely defined convulsant action of phenytoin (PHT) at toxic concentrations in humans. A retrospective chart review (1979-1985) yielded 96 cases (90 patients), meeting both clinical and laboratory criteria for PHT intoxication. Seven patients, all with epilepsy, had one or more seizures while toxic. However, in only two patients (2.1%) with serum concentrations of 93.2 and 69.7 micrograms/ml was a causal relationship deemed highly probable. Seizures did not occur in most toxic epileptic patients with total serum PHT concentrations as high as 85.1 micrograms/ml or in any of the nonepileptic patients with concentrations as high as 64.2 micrograms/ml. The lack of convulsant action of PHT in these patients suggests that seizure risk may be multifactorial and also that PHT is a weak convulsant. We conclude that PHT at very high concentrations can rarely exacerbate seizures or even precipitate generalized status in some epileptic patients, a paradoxical effect.- - - - - - - - - - ranking = 0.25keywords = intoxication (Clic here for more details about this article) |
9/21. Epileptic Munchausen's syndrome: a form of pseudoseizures distinct from hysteria and malingering.A young woman with seizures and status epilepticus sought and obtained hospitalization in at least 25 hospitals in the province of quebec between 1980 and 1987. She was thought to have uncontrolled epilepsy; her treatment led to intoxication with anticonvulsants and once to anesthesia for three consecutive periods of 7 days each. The nonepileptic nature of her attacks was proven and a diagnosis of Munchausen's syndrome made. She was transferred to a psychiatric center where she committed suicide. We found no documented cases of epileptic chronic factitious disorder in the literature.- - - - - - - - - - ranking = 0.25keywords = intoxication (Clic here for more details about this article) |
10/21. alcohol withdrawal seizures.Seizures that occur in relation to alcohol withdrawal, following a period of prolonged intoxication in serious alcoholics, constitute a special syndrome with important prognostic and therapeutic implications. Inpatient management is desirable to eliminate other causes of seizures that occur for the first time in adult life and because such patients are at substantial risk for additional seizures and the development of delirium tremens. drug therapy with benodiazepines may be effective during the withdrawal period but long-term anticonvulsant treatment is of no value.- - - - - - - - - - ranking = 0.25keywords = intoxication (Clic here for more details about this article) |
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