title: Drug-induced status epilepticus.
abstract: Drug-induced status epilepticus (SE) is a relatively uncommon phenomenon, probably accounting for less than 5% of all SE cases, although limitations in case ascertainment and establishing causation substantially weaken epidemiological estimates. Some antiepileptic drugs, particularly those with sodium channel or GABA(γ-aminobutyric acid)-ergic properties, frequently exacerbate seizures and may lead to SE if used inadvertently in generalized epilepsies or less frequently in other epilepsies. Tiagabine seems to have a particular propensity for triggering nonconvulsive SE sometimes in patients with no prior history of seizures. In therapeutic practice, SE is most commonly seen in association with antibiotics (cephalosporins, quinolones, and some others) and immunotherapies/chemotherapies, the latter often in the context of a reversible encephalopathy syndrome. Status epilepticus following accidental or intentional overdoses, particularly of antidepressants or other psychotropic medications, has also featured prominently in the literature: whilst there are sometimes fatal consequences, this is more commonly because of cardiorespiratory or metabolic complications than as a result of seizure activity. A high index of suspicion is required in identifying those at risk and in recognizing potential clues from the presentation, but even with a careful analysis of patient and drug factors, establishing causation can be difficult. In addition to eliminating the potential trigger, management should be as for SE in any other circumstances, with the exception that phenobarbitone is recommended as a second-line treatment for suspected toxicity-related SE where the risk of cardiovascular complications is higher anyways and may be exacerbated by phenytoin. There are also specific recommendations/antidotes in some situations. The outcome of drug-induced status epilepticus is mostly good when promptly identified and treated, though less so in the context of overdoses. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: IMBE, St George's University of London, London SW17 0RE, UK; Atkinson Morley Epilepsy Group, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, UK. Electronic address: hannahrc@sgul.ac.uk.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Cock
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D009557:Nipecotic Acids / Q000009:adverse effects / Q000627:therapeutic use; D010634:Phenobarbital / Q000009:adverse effects / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D000078308:Tiagabine; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D009557:Nipecotic Acids; D005680:gamma-Aminobutyric Acid; D010672:Phenytoin; D010634:Phenobarbital; D000078308:Tiagabine
keywords: Antibiotic; Antidepressant; Drug-induced seizure; Overdose; Status epilepticus; Treatment