1/11. Myoclonic status epilepticus following high-dosage lamotrigine therapy.An 8-year-old girl with Lennox-Gastaut syndrome showed a partial reduction in seizure frequency when lamotrigine (LTG), 15 mg/kg per day, was added to clobazam (CLB) and vigabatrin (VGB). An increase in LTG dosage to 20 mg/kg per day produced no further improvement and was followed by myoclonic status epilepticus. The condition developed insidiously and ultimately became stable. Video-EEG polygraphy and jerk-locked back-averaged EEG demonstrated continuous myoclonus of cortical origin. Discontinuation of LTG resulted in rapid disappearance of clinical and electrophysiological manifestations of myoclonic status epilepticus. No episodes of myoclonus occurred in the subsequent 2 years, during which CLB and VGB were kept unchanged. The striking response to drug discontinuation suggests that LTG may have played a role in the precipitation of status, possibly within the context of paradoxical intoxication.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/11. lithium intoxication mimicking clinical and electrographic features of status epilepticus: a case report and review of the literature.A 58-year-old patient who was somnolent, distractible and confused is presented. She was previously treated with lithium, and a plasma level was mildly elevated at 1.7 mmol/l (normal 0.5-1.5 mmol/l). The EEG was suggestive of electrographic status epilepticus. Following treatment with i.v. lorazepam, neither mental status nor EEG abnormalities improved. She had a full recovery of mental function and markedly improved EEG findings following discontinuation of lithium. The EEG is an effective tool for diagnosing lithium neurotoxicity in patients with normal or mildly elevated lithium plasma levels. However, caution is needed before making an assumption of status epilepticus.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
3/11. status epilepticus induced by star fruit intoxication in patients with chronic renal disease.Star fruit has been reported as containing neurotoxins that often cause severe neurological complications in patients with chronic renal disease. We report two patients with chronic renal failure at a pre-dialyzed stage who developed refractory status epilepticus after ingestion of star fruit. In addition, we review 51 cases in the literature. Among 53 patients, 16 patients presented with epileptic seizures (30%). The mortality rate was as high as 75% in patients with seizures. On the other hand, in patients without seizures, the mortality rate was only 0.03%. There is a poor correlation with the degree of underlying renal function and mortality due to intoxication. We propose that epileptic seizure is significantly associated with poor prognosis, and that status epilepticus is an unpredictable and potentially fatal complication in star fruit intoxication. We advise consultant neurologists that star fruit intoxication must be considered when patients with chronic renal disease present with seizures or other unexplained neurological or psychiatric symptoms. Since no effective treatment has been established, star fruit consumption should be avoided in patients with chronic renal disease, especially in the elderly.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
4/11. Non-convulsive status epilepticus during lithium treatment at therapeutic doses.The purpose of this study is to report the case of a patient with normal lithium serum levels who developed non-convulsive status epilepticus (NCSE). A 52-year-old woman with bipolar disorder type I (DSM-IV) treated with lithium experienced bradypsychism and episodes of confusion and spatial disorientation without signs or symptoms of lithium intoxication. lithium serum levels were in the normal range. A brain MR scan was negative; the electroencephalogram (EEG) revealed a background 3-4 Hz delta rhythm and diffuse spike discharges. Prompt EEG and clinical response to intravenous diazepam therapy was observed. Based on these findings, a diagnosis of NCSE was made and lithium therapy was withdrawn, resulting in symptom remission and EEG normalization. The treatment was resumed after two months to test the correlation between NCSE and lithium therapy. Resumption of therapeutic range lithium induced the same clinical symptoms and EEG patterns; the therapy was thus definitively discontinued. The present data-signalling the temporal correlation of clinical and EEG changes with drug administration and withdrawal-suggest that even in the therapeutic range lithium treatment may trigger NCSE onset in predisposed subjects.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/11. Response of life threatening dimenhydrinate intoxication to sodium bicarbonate administration.This is a report of an intentionally administered overdose of dimenhydrinate to a 4 month-old infant who subsequently presented with status epilepticus, coma, and life threatening ventricular dysrhythmias. Initial toxicologic analysis of the serum by fluorescence polarization immunoassay was positive for tricyclic antidepressants. Repeat analysis of the serum at 6 hours post ingestion by gas chromatography mass spectrometry analysis defined diphenhydramine 4.8 micrograms/mL. The infant was managed with IV sodium bicarbonate as utilized in tricyclic antidepressant intoxication. The dysrhythmias resolved and the infant recovered without sequelae.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
6/11. Complex partial status epilepticus provoked by ingestion of alcohol: a case report.A 27-year-old man had a 5-year history of a peculiar state characterized by clouded consciousness provoked by ingestion of alcohol. The episode was identified electroclinically as nonconvulsive status epilepticus and was activated by ingestion of alcohol. Single-photon emission computed tomography (SPECT) examination during the nonconvulsive status epilepticus showed increased regional cerebral perfusion in the right frontal region. This finding, along with the EEG expressions, supports a cortical origin of the nonconvulsive status epilepticus and a diagnosis of complex partial status epilepticus (CPSE). To our knowledge, this is the first report of a documented case of CPSE during intoxication provoked by alcohol ingestion and also of a SPECT examination during CPSE.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/11. Electroencephalographic changes during and after water intoxication.A case of water intoxication with remarkable hyponatremia was investigated with a special reference to EEG changes during and after the episode. The patient recovered his EEG as his consciousness disturbance had improved through an intravenous infusion of high osmolality saline, correlating with the serum sodium level. Further, the clinical importance of recording EEG for water intoxication was stressed.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
8/11. Acute water intoxication in healthy infants.We have described two infants with profound hyponatremia and seizures due to metabolic derangements resulting from inappropriate feeding of large volumes of solute-poor liquids. All of the 23 similar cases in the current literature described children with normal renal and neurologic function before and after the episode of hyponatremia. The chronic feeding of solute-poor fluids in these infants impaired their ability to excrete free water, and continued feeding of solute-poor fluids resulted in progressive hyponatremia and convulsions. Upon reinstitution of normal sodium intake, all metabolic abnormalities disappeared.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
9/11. water intoxication with seizures.Presented is the case of a normal two-month-old girl who developed seizures secondary to water intoxication. The infant had been fed 20 to 30 oz of water daily for three days, while her usual formula was withheld because of vomiting and diarrhea. On the day of admission, the infant exhibited signs of water intoxication in the form of lethargy, vomiting, and seizures. hyponatremia, hypothermia, and hyperglycemia were noted on admission, and are common features of the syndrome. The patient responded well to fluid restriction and salt replacement. Previous reports have attributed water intoxication to feeding mismanagement, vigorous hydration, dilute formulas, and swimming lessons.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
10/11. Methyl bromide intoxication: neurologic features, including simulation of reye syndrome.Three family members intoxicated with methyl bromide presented with a variety of neuropsychiatric manifestations including coma, severe status epilepticus, hyporeflexia, and acute psychosis. The simulation of reye syndrome in the child emphasizes the need for careful toxicologic screening of all children presenting with this syndrome. The initial diagnostic difficulty encountered in these cases emphasizes the need for heightened awareness of the toxic chemicals used in local industries and the clinical manifestations of their intoxication.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
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