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Seizures, complicated by spinal fracture: case report A 39-year-old woman was taking bupropion [amfebutamone], nortriptyline and tramadol [dosages, durations and indications not stated] as prescribed. She was found confused and in an awkward position in her bed, and was hospitalised for severe back pain. Soon after arrival she experienced a generalised convulsion, followed by worsening back pain. Thoracic spine x-ray and MRI confirmed vertebral compression fractures from T2-T5, whilst EEG changes suggested a metabolic or toxicological process. Bupropion and tramadol were discontinued and she had no further seizures. Author comment: "It is likely that her three proconvulsant medications - even at therapeutic doses - synergistically lowered her seizure threshold or even precipitated her seizures." Stellpflug SJ, et al. Which xenobiotic(s) could be responsible for the radiologic findings below?: Answer: Any proconvulsant xenobiotic, in this case tramadol, bupropion, and nortriptyline. Journal of Medical Toxicology - official journal of the American College of Medical Toxicology 6: 72-73, No. 1, Mar 2010. Available 803021716 from: URL: http://dx.doi.org/10.1007/s13181-010-0043-4 - USA

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Reactions 26 Jun 2010 No. 1307