title: Epileptic seizures, coma and EEG burst-suppression from suicidal bupropion intoxication.
abstract: Bupropion, an amphetamine-like dual mechanism drug, is approved and increasingly used for the treatment of major depression, and its use is associated with a dose-dependent risk of epileptic seizures. Suicide attempts are frequent in major depression and often an overdose of the drugs available is ingested. Therefore, it is important to be aware of the clinical course, including EEG and neurological symptoms, as well as treatment and prognosis of bupropion intoxication. We report on the clinical and EEG course of a women who ingested 27 g of bupropion in a suicide attempt. Myoclonic seizures were followed by generalized tonic-clonic seizures and coma associated with EEG burst-suppression and brief tonic seizures. Active carbon and neuro-intensive care treatment, including respiratory support, were given. Within three days, the patient returned to a stable clinical condition with a mildly encephalopathic EEG. In conclusion, bupropion intoxication requires acute intensive care treatment and usually has a good prognosis, however, misinterpretation of the clinical and EEG presentation may lead to errors in management.
authors.affiliation: Epilepsy Center Hessen - Marburg, Department of Neurology, University Hospital Marburg and Philipps-University Marburg, Marburg, Clinic for Psychiatry and Psychotherapy, Vitos Gießen-Marburg, Marburg.
authors.forename: Anna Hiro
authors.initials: AH
authors.lastname: Noda
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Marburg and Philipps -University Marburg, Marburg.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schu
authors.affiliation: Department of Nephrology, University Hospital Marburg and Philipps-University Marburg, Marburg.
authors.forename: Tanja
authors.initials: T
authors.lastname: Maier
authors.affiliation: Epilepsy Center Hessen - Marburg, Department of Neurology, University Hospital Marburg and Philipps-University Marburg, Marburg.
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.affiliation: Epilepsy Center Hessen - Marburg, Department of Neurology, University Hospital Marburg and Philipps-University Marburg, Marburg, Epilepsy Center Frankfurt Rhine-Main, Neurocenter, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
mesh_terms: D016642:Bupropion / Q000633:toxicity*; D003128:Coma / Q000139:chemically induced* / Q000628:therapy; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004569:Electroencephalography / Q000187:drug effects*; D004827:Epilepsy / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D013406:Suicide, Attempted
chemical_list: D016642:Bupropion
keywords: bupropion intoxication; coma; seizure