Orofacial automatisms induced by acute withdrawal from high-dose midazolam mimicking nonconvulsive status epilepticus in a child.
Nonconvulsive Status Epilepticus (NCSE) is not uncommon in children, and can be challenging to diagnose and treat. Etiologies vary widely and include infection, trauma and acute withdrawal from medications such as anticonvulsants. We report a child who experienced orofacial dyskinesias concerning for NCSE after withdrawal from high dose benzodiazepines andopiates. Automonic signs typically associated with sedative withdrawal were absent and treatment with benzodiazepines did not improve his symptoms. Diagnostic testing was negative, including electroencephalogram, and resolution was complete within five days. Our case demonstrates the orofacial dyskinesias that may occur during sedative medication withdrawal, and highlights potential confusion with non-convulsive status epilepticus.
Epstein
David
D
National Naval Medical Center, Bethesda, MD, USA.
Difazio
Marc
M
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000209:etiology*; D004569:Electroencephalography / Q000187:drug effects; D004826:Epiglottitis / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009460:Neurologic Examination / Q000187:drug effects; D012121:Respiration, Artificial; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology*
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam