Reactions 544 - 1 Apr 1995

★ STheophylline

First report of infantile spasms: case reportA direct causal relationship between infantile spasms and an

excessive theophylline concentration was suggested in a6-month-old girl.

During hospital admission for asthma, the infant beganslow-release theophylline [Slo-phyllin®] 60mg bid. Her asthmaattack resolved and she was discharged. however, 3 days later,she was again admitted with a 12-hour history of episodicjerking movements. Her EEG showed a hypsarrhythmicpattern consistent with infantile spasms. her theophyllineconcentration was 108 µmol/L; the suggested upper limit forinfants is 77 µmol/L.

Theophylline was discontinued. however, as her spasmspersisted following day, nitrazepam was started, Two dayslater, her infantile spasms had resolved and her EEG wasnormalising. her asthma was effectively treated with nebulisedbudesonide. Nitrazepam was discontinued after 4 months. AnEEG taken after a further 4 months was normal. The girl did notexperience any recurrence of infantile spasms during 3 year’sof follow-up.

Author comment: ‘We have carried out an extensive searchof the literature and did not find any previous reports ofinfantile spasms in association with theophylline toxicity. Thetoxic levels were probably caused by too large an initial dose.’Shields MD, et al. Infantile spasms associated with theophylline toxicity. ActaPaediatrica 84: 215-217, Feb 1995 - Northern Ireland 800343552

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Reactions 1 Apr 1995 No. 5440114-9954/10/0544-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved