Theophylline Status epilepticus following electroconvulsive therapy: case report

A 23-year-old man was hospitalised after attempting suicide with a handful of terbutaline tablets and doxepin 375mg. Acute exacerbation of insidious onset schizophrenia was diagnosed. Medical history was remarkable for generalised atopic dermatitis and chronic bronchial asthma treated with theophylline 1200 mgjday. He had no history of seizures.

Electroconvulsive therapy was administered following a second suicide attempt after 4 weeks' therapy with haloperidol, up to 60 mg/day. The generalised tonic clonic seizure during the first episode of electroconvulsive therapy had a motor manifestation of 135 sec. Oesophagitis was diagnosed after the patient developed a low grade fever on the same day and cimetidine and antacids were administered in addition to haloperidol 60 mgjday, benzatropine 4 mgjday, lorazepam 2 mgjday and theophylline 600mg bid. Electroconvulsive therapy was continued 2 days later. IV anaesthetics included atropine 0.4mg, methohexital 50mg and suxamethonium 35mg.

The patient experienced an extremely prolonged generalised tonic clonic seizure which necessitated the administration of IV diazepam. The seizure was finally controlled after 12 min of clear-cut motor manifestations. The occurrence of haematemesis prompted intubation with complete muscle paralysis and continuous ventilation. Arterial blood, sampled when the patient was intubated and was receiving 100% oxygen, revealed pH 7.23, pC02 56.7mm Hg, p02 414.2mm Hg, HC03 23.2 mm/L and base excess -5.0 mm/L. Theophylline serum level was 21 ,ug/ml and serum albumin was normal; 4.5 ,ug/dl.

The patient responded to 6 further episodes of electroconvulsive therapy which were administered under a longer period of general anaesthesia. Seizures of > 90 sec were treated with IV diazepam and status epilepticus did not occur. Theophylline was the most probable cause of seizures, indicating that ... caution needs to be exercised In the administration of ECT [electroconvulsive therapy] to patients receiving theophylline, even with blood levels In the therapeutic range'.

Devanand DP. Decina P. Sackeim HA, Prudic J. Journal of Clinical Psychopharmacology 8: 153,

Apr 1988 "''

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