Reactions 510 - 16 Jul 1994

STheophylline

Amnesia following seizures: 2 case reportsTwo patients developed a persistent disabling amnesic

syndrome after seizures associated with oral theophyllinetreatment.

The first patient, a 68-year-old man, received aminophylline225mg qid for a chest infection associated with chronicobstructive airways disease. After 3 weeks of therapy the mandeveloped status epilepticus of 1 hour duration without anoxicepisodes, which was treated with IV phenytoin. Theophyllineserum levels were indicative of toxicity. The man regainedconsciousness but remained confused. One month later thepatient still had memory problems and was unable to continuein his previous work. Verbal memory, recall, and learningability continued to show a deficit 4 months after the episode.

The second patient, a 16-year-old girl, had a generalisedseizure after developing an exacerbation of her asthma whiletaking theophylline 500 mg/day, ciprofloxacin, clarithromycin,cotrimoxazole [trimethoprim/sulfamethoxazole] andflucloxacillin; she also had cystic fibrosis. She becameunconscious and cyanosed, and had another generalisedseizure. She was ventilated and treated with IV anticonvulsantsand although she regained consciousness 6 hours later, sheremained disorientated. Four months later a pronounced shortterm memory deficit was still present, and she had notreturned to school.

Author comment: ‘The serum concentration of theophyllineis a definite factor in the induction of seizures.’ Theophyllineconcentrations should be monitored often and maintained atthe lower end of the therapeutic range in patients withpredisposing disorders during chronic oral treatment.O’Riordan JI, et al. Amnesic syndrome after theophylline associated seizures:iatrogenic brain injury. Journal of Neurology, Neurosurgery and Psychiatry 57:643-645, May 1994 - Ireland 800268025

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Reactions 16 Jul 1994 No. 5100114-9954/10/0510-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved