title: Seizures after heart transplantation--two cases of non-immunosuppressant drug interactions in young patients.
abstract: BACKGROUND
  Neurological complications occur in 30-80% of patients following heart transplantation, and seizures account for 2-20% of these sequelae. The main risk factors are toxicity due to immunosuppression, infections, and brain lesions. We present 2 cases of grand mal type attacks that occurred on the 7th and 15th postoperative days. The origin of the attacks was an unusual interaction between 2 non-immunosuppressive drugs (metoclopramide and theophylline).
  
  
  METHODS
  We present 2 cases of seizure episodes during the early postoperative period in young heart transplant recipients (a 26-year-old female and a 33-year-old man). Grand mal type attacks occurred on the 7th and 15th postoperative day, respectively. Both patients were treated with standard triple immunosuppressive therapy including tacrolimus, mycophenolate mofetil, and steroids. Therapy with metoclopramide was started because the patients reported gastrointestinal disturbances. Theophylline was administered due to postoperative bradycardia. Serum theophylline levels were 33 and 34 mcg/ml, respectively. There were no neurological deficits noticed thereafter. The magnetic resonance imaging (MRI) was negative for stroke and central nervous system infection in both cases.
  
  
  CONCLUSIONS
  We conclude that theophylline overdose combined with metoclopramide may provoke new-onset seizures, especially in young patients following heart transplantation.
authors.affiliation: Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Urbanowicz
authors.affiliation: Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pawłowska
authors.affiliation: Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Buczkowski
authors.affiliation: Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Bartłomiej
authors.initials: B
authors.lastname: Perek
authors.affiliation: Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Baszyńska-Wachowiak
authors.affiliation: Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Straburzyńska-Migaj
authors.affiliation: Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Jemielity
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects; D001919:Bradycardia / Q000188:drug therapy; D001921:Brain / Q000187:drug effects / Q000473:pathology; D065127:Dopamine D2 Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D004347:Drug Interactions; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000009:adverse effects; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D011183:Postoperative Complications / Q000188:drug therapy; D013806:Theophylline / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood
chemical_list: D000932:Antiemetics; D065127:Dopamine D2 Receptor Antagonists; D010726:Phosphodiesterase Inhibitors; D013806:Theophylline; D008787:Metoclopramide