Evolving epidemiology of drug-induced seizures reported to a Poison Control Center System.
BACKGROUND
We sought to determine whether or not the causes and consequences of drug-induced seizures have changed in the last decade.


METHODS
We conducted a retrospective review of all calls to the California Poison Control System in 2003 in which seizures occurred in association with poisoning or drug intoxication. We reviewed the poison center chart of each case to determine the drug(s) involved, the type of seizures, and the medical outcome. We compared the cause of reported seizures to that found in previous investigations.


RESULTS
386 cases were evaluated and related to poisoning or drug intoxication. The leading causes of seizures were bupropion (89 cases, 23%), diphenhydramine (32 cases, 8.3%), tricyclic antidepressants (30 cases, 7.7%), tramadol (29 cases, 7.5%), amphetamines (27 cases, 6.9%), isoniazid (23 cases, 5.9%), and venlafaxine (23 cases, 5.9%). Since 1993, there was a statistically significant increase in antidepressant related seizures but a decrease in TCA and cocaine related seizures. In 265 patients (68.6%) only a single seizure was reported, while 3.6% (14 cases) reported status epilepticus. Two-thirds (65.5%) of the cases involved suicide attempts and 14.8% the direct result of drug abuse. There were 7 deaths. Of the 7 deaths, 4 people had significant hyperthermia. There was a statistically significant increased risk of death associated with stimulant exposure.


CONCLUSIONS
While tricyclic antidepressants, antihistamines, stimulants, and isoniazid remain common causes of drug induced seizures, bupropion, tramadol, and venlafaxine have emerged as common causes of drug-induced seizures for which poison center consultation is requested.
Thundiyil
Josef G
JG
California Poison Control System - San Francisco Division, School of Pharmacy, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA. joseft@mindspring.com
Kearney
Thomas E
TE
Olson
Kent R
KR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D012640:Seizures / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality