title: Tiagabine-induced stupor in patients with psychogenic nonepileptic seizures: nonconvulsive status epilepticus or encephalopathy?
abstract: BACKGROUND
  Nonconvulsive status epilepticus has been rarely reported with tiagabine (TGB) use.
  
  
  METHODS
  We report findings from continuous video-EEG monitoring and serial neurological examinations during prolonged episodes of stupor associated with TGB use in three patients who did not have epilepsy.
  
  
  RESULTS
  All three patients had emergence of new type of events after starting TGB treatment. All three patients had gradual decline in responsiveness to verbal stimuli, intermittent twitching of the upper extremities, and urinary incontinence. The corresponding EEG showed gradual build-up of generalized bisynchronous delta-wave activity with subsequent intermingled sharp transients. Two patients did not respond to IV lorazepam, one of whom also did not respond to IV phenytoin. The EEG slowly normalized in conjunction with associated clinical improvement. Habitual seizures were found to be psychogenic, with no interictal evidence for epilepsy.
  
  
  CONCLUSIONS
  Tiagabine-related stupor may represent a form of toxic encephalopathy in some cases rather than nonconvulsive status epilepticus.
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232-2551, USA. nabil.azar@vanderbilt.edu
authors.forename: Nabil J
authors.initials: NJ
authors.lastname: Azar
authors.forename: Nandakumar
authors.initials: N
authors.lastname: Bangalore-Vittal
authors.forename: Amir
authors.initials: A
authors.lastname: Arain
authors.forename: Bassel W
authors.initials: BW
authors.lastname: Abou-Khalil
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D058256:Brain Waves / Q000187:drug effects / Q000502:physiology; D003291:Conversion Disorder / Q000188:drug therapy; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology; D009557:Nipecotic Acids / Q000009:adverse effects*; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis; D053608:Stupor / Q000139:chemically induced* / Q000175:diagnosis; D000078308:Tiagabine; D014741:Video Recording
chemical_list: D000927:Anticonvulsants; D009557:Nipecotic Acids; D000078308:Tiagabine