Tiagabine-related status epilepticus: a case report and systematic literature review
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REVIEW ARTICLE
Tiagabine‑related status epilepticus: a case report and systematic literature review Geoffroy Hariri1,2,5 · Alexis Ferre1 · Stephane Legriel1,3,4 Received: 27 April 2020 / Accepted: 3 August 2020 © Belgian Neurological Society 2020
Abstract Tiagabine-related status epilepticus (SE) is an uncommon complication of tiagabine use. We aimed to detail the features and outcomes in a patient with tiagabine poisoning and review the relevant literature. We describe a case of tiagabine-related SE and literature review based on a 1995–2019 PubMed search. We report the case of a 30-year-old man with super-refractory SE after tiagabine poisoning. He fully recovered after 72 h of general anesthesia and was discharged from the ICU on day 16. A literature review showed distinct features among patients with tiagabine-related SE. Tiagabine side effects were characterized by non-convulsive SE after a slight increase in tiagabine dose and a rapid favorable evolution after benzodiazepine and early tiagabine withdrawal. Generalized convulsive SE was a complication of voluntary or involuntary tiagabine poisoning and was particularly refractory. Both presentations are characterized by a return to baseline after prompt and adequate management. Tiagabine-related SE electroclinical features vary according to the underlying pathophysiological mechanism and can be life threatening. Recovery is the rule after tiagabine withdrawal and SE management with progressive therapeutic escalation guided by response to prior anticonvulsant treatments. Keywords Case report · Status epilepticus · Coma · Tiagabine Abbreviations SE Status epilepticus ICU Intensive care unit GABA Gamma-aminobutyric acid GAT-1 GABA transporter 1 IQR Interquartile range * Geoffroy Hariri [email protected] Alexis Ferre aferre@ch‑versailles.fr Stephane Legriel slegriel@ch‑versailles.fr 1
Intensive Care Unit, Centre Hospitalier de Versailles–Site André Mignot, 78150 Le Chesnay, France
2
Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint‑Antoine, 75571 Paris Cedex 12, France
3
IctalGroup, Le Chesnay, France
4
University Paris-Saclay, UVSQ, INSERM, CESP, Team « PsyDev », Villejuif, France
5
Medical Intensive Care Unit, Centre Hospitalier Universitaire Saint-Antoine, Assistance Publique Hôpitaux de Paris, 184 Rue du Faubourg Saint‑Antoine, 75012 Paris, France
EEG Electroencephalogram NCSE Non-convulsive status epilepticus CSE Convulsive status epilepticus 5-HT2 5-Hydroxytryptamine 2 GCSE Generalized convulsive status epilepticus
Introduction Tiagabine is a selective inhibitor of GAT-1, the principal transporter of gamma-aminobutyric acid (GABA) into neurons and glia. Inhibition of GABA reuptake leads to an increasing effect of GABA, an anticonvulsant mechanism explaining the use of tiagabine as an effective antiepileptic drug [1] Tiagabine has been proposed for other situations, such as traumatic stress or generalized anxiety disorder [2]. However, sever
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