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Various toxicities: case report A 30-year-old man developed convulsive status epilepticus following intentional overdose of tiagabine, which was further worsened by phenytoin and levetiracetam. Additionally, he exhibited lack of efficacy during treatment with clonazepam and sodium valproate for the status epilepticus, and exhibited clinical recurrence in form of generalised tonic-clonic seizures secondary to tapering of midazolam and propofol [not all dosages and routes stated; duration of treatment to reaction onsets not stated]. The man, who had a history of depression, alcohol addiction and drug addiction, had been receiving treatment with tiagabine for general anxiety. At 2am, he was found alternating between agitation and drowsiness associated with diffuse myoclonus at home by his grandmother. He was shifted to a hospital in France; during transportation, he received two bolus doses of 1mg clonazepam. At the emergency room, he was noted in a state of altered consciousness with pupillary mydriasis and myoclonus. GCS score was found to be 7. Physical examination showed the following: body temperature 36.5°C, BP 109/66mm Hg and HR 94 beats/min. Subsequently, he received a 20-minute loading dose of phenytoin 1500mg. He was then transferred to the ICU with ongoing myoclonus at 8am. Laboratory tests did not reveal any metabolic disturbances. Toxicological screening using blood and urine samples was negative for ethanol, cocaine, opiates and benzodiazepines. Cerebral CT-scan and cerebrospinal fluid analysis were normal. EEG revealed 2-3Hz generalised sharp wave discharges, which were resistant to levetiracetam 1000mg and sodium valproate 2500mg loading doses. He was intubated, mechanically ventilated and administered propofol and midazolam titration boluses for the suppression of burst EEG pattern. During tapering of propofol and midazolam doses, he experienced recurrence in form of generalised tonic-clonic seizures. The blood tiagabine level measured at 12 hours after ICU admission, was found to be 284 ng/mL. Hence, he was diagnosed with convulsive status epilepticus related to tiagabine poisoning after ingestion of the drug in overdose. Additionally, potential aggravation of the convulsive status epilepticus secondary to phenytoin and levetiracetam was considered. The man’s treatment was started with sodium thiopental for 48 hours. Also, his tiagabine level decreased to 0 ng/mL. No further recurrence was noted even after discontinuation of propofol and midazolam. He completely recovered after 72 hours, and was discharged from the ICU on day 16. Hariri G, et al. Tiagabine-related status epilepticus: a case report and systematic literature review. Acta Neurologica Belgica 120: 1283-1288, No. 6, Aug 2020. Available 803517218 from: URL: http://doi.org/10.1007/s13760-020-01464-6

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Reactions 28 Nov 2020 No. 1832