Theophylline

Status epileplicus with concurrent electroconvulsive therapy

Depression in a 71-year-old woman was treated with electroconvulsions when no improvement was noled with doxepin or trazodone. The patient was taking prednisone 2.5 mgjday and theophylline for mild to moderate obstructive lung disease. Premedication consisted of sodium thiopentone atropine and succinylcholine, and throughout electroconvulsive therapy oxygenation was maintained with 100% oxygen by bag or mask. During the procedure generalised seizures were noted which were managed with diazepam, sodium thiopentone, phenytoin and phenobarbitone. Serum electrolytes, glucose, calcium and magnesium were within normal limits and serum theophylline 3 hours before the procedure was 22.6 j.lgjml. The level 9 hours after the procedure was 7.B j.lg/ml. Electroencephalography done approximately 1 hour after the seizures showed a burst-suppression pattern. No underlying seizure disorder was identified. A CT-scan obtained several hours after electroconvulsive therapy showed mild generalised atrophy which was unrelated to the seizures. Spontaneous theophylline-induced seizures are most often seen with serum drug levels > 50 I!gjml. The prolonged seizures in this patient occurred at a relatively low serum theophylline concentration and with concurrent electroconvulsive therapy. Electroconvulsive therapy is only rarely associated with prolonged seizures. 'Physicians who evaluate the status of patients before electroconYUltiw therapy should be aware of the potential risk of the concomitant use of theophylline, particularly with serum levels of the drug above the accepted therapeutic range.' The mechanism of action is not known but it is possible that theophylline may lower the seizure threshold.

Peters, s.a. et aL Mayo Clinic Proceedings 59: 568 (Jul·Aug 1984)

0157-7271/84/1110-0009/0$01.00/0 @ADIS Press Reactions 10 Nov 1984 9