Reactions 1214 - 9 Aug 2008

STheophylline

Seizures in an elderly patient: case reportAn 81-year-old woman experienced seizures whilst

receiving theophylline for chronic bronchitis.The woman had a previous history of seizures which had

resolved with valproic acid treatment. Approximately 11 yearslater she started receiving oral theophylline 400 mg/day, andafter about 2 months, she had a seizure and was hospitalised.Neurological examination revealed a consciousness score ofJCS 20, clonic seizures, and left-sided flaccid paralysis, tendonreflex tremors and a positive Babinski reflex. Her bloodtheophylline concentration was within the therapeutic range.Periodic lateralised epileptiform discharges were evident onEEG and brain MRI showed hyperintense signals in the rightcerebral cortex and thalamus, both suggestive of acuteencephalopathy with febrile convulsive status epilepticus. Shehad increased blood flow in the right cerebral hemisphere asnoted on scintigraphy.

Oral theophylline was switched to IV aminophylline. Thewoman received diazepam and phenytoin for partial seizuresbut she was in status epilepticus. The seizures were thoughtpossibly associated with theophylline so aminophylline wasdiscontinued. Her seizures abated, and her cognitiveimpairment gradually normalised over 3 weeks. About1 month later, the majority of her cerebral findings hadnormalised, although the paralysis remained.

More than 1 month after admission, the woman haddiarrhoea followed by clonic convulsions. Laboratory analysisrevealed an undetectable serum pyridoxine level; vitamin Bcomplex administration led to resolution of seizures. At lastfollow-up she still had paralysis and was wheelchair-bound.

Author comment: Although her serum vitamin B6 wasnot measured at the time of admission, it is thought that theonset of seizures may be due to a long-term pre-existingvitamin B6 deficiency, aggravated by theophyllineadministration.Kuwahara H, et al. An 81-year-old woman with theophylline-associated seizuresfollowed by partial seizures due to vitamin B6 deficiency. Rinsho Shinkeigaku 48:125-129, No. 2, Feb 2008 [Japanese; summarised from a translation] -Japan 801104281

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Reactions 9 Aug 2008 No. 12140114-9954/10/1214-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved