title: Drug-induced seizures in children and adolescents presenting for emergency care: current and emerging trends.
abstract: BACKGROUND
  Seizures may be the presenting manifestation of acute poisoning in children. Knowledge of the etiologic agent, or likely drug-class exposure, is crucial to minimize morbidity and optimize care.
  
  
  OBJECTIVE
  To describe the agents most commonly responsible for pediatric drug-induced seizures, whose evaluation included a medical toxicology consultation in the United States.
  
  
  METHODS
  Using the 37 participating sites of the Toxicology Investigators Consortium (ToxIC) Case Registry, a cross-country surveillance tool, we conducted an observational study of a prospectively collected cohort. We identified all pediatric (younger than 18 years) reports originating from an Emergency Department (ED) which included a chemical or drug-induced seizure, and required a medical toxicology consultation between April 1, 2010 and March 31, 2012. Results. We identified 142 pediatric drug-induced seizure cases (56% male), which represent nearly 5% of pediatric cases requiring bedside consultation by medical toxicologists. One-hundred and seven cases (75%) occurred in children aged 13-18 years, and 86 (61%) resulted from intentional ingestions. Antidepressants were the most commonly identified agents ingested (n = 61; 42%), of which bupropion was the leading drug (n = 30; 50% of antidepressants), followed by anticholinergics/antihistamines (n = 31; 22%). All antidepressant-induced seizures in teenagers were intentional and represented self-harm behavior. Sympathomimetic agents, including street drugs, represent the most common agents in children younger than 2 years (n = 4/19).
  
  
  CONCLUSIONS
  Antidepressants, and specifically bupropion, are presently the most common medications responsible for pediatric drug-induced seizures requiring medical toxicology consultation in the United States. In teenagers presenting with new-onset seizures of unknown etiology, the possibility of deliberate self-poisoning should be explored, since most drug-induced seizures in this age group resulted from intentional ingestion.
authors: Divisions of Emergency Medicine, Hospital for Sick Children , Toronto, ON , Canada.
authors: Y
authors: Y
authors: Finkelstein
authors: J R
authors: JR
authors: Hutson
authors: S B
authors: SB
authors: Freedman
authors: P
authors: P
authors: Wax
authors: J
authors: J
authors: Brent
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000928:Antidepressive Agents / Q000506:poisoning; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011041:Poisoning / Q000453:epidemiology*; D011159:Population Surveillance; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012640:Seizures / Q000139:chemically induced*; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents