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Toxic Seizures
Timothy B. Erickson, MD, FACEP, FACMT University
of Illinois _at_ Chicago Toxikon Consortium
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Less Common Causes of Toxic or Drug-Induced
Seizures
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CASE 1

• A 37 year old patient presents by paramedics
  after his father found him unresponsive with
  tonic-clonic seizures. The patient had recently
  ingested oil of wormwood he had purchased on
  the internet.

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CASE 2

• A 43 year old male has an argument with his wife.
  He goes to the shed in the backyard and then
  crawls into bed with his upset spouse. He calmly
  informs her that he just drank a can of
  gopher-getter. She ignores him and falls
  asleep.
• One hour later, she is awakened by his seizure
  activity and notes he is seizing with his eyes
  wide open.

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CASE 3

• Two brothers are forging through the woods with a
  plan to live off the fat of the land. They
  arrive by a small mountain stream and discover
  some wild carrot roots. They build a campfire,
  and cook some wild carrot soup. 30 minutes
  after dinner, they are both actively seizing.

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CASE 4

• A male is found unresponsive by state police his
  car which is discovered off the road, trapped in
  a snow bank. There are no signs of obvious
  trauma. Paramedics are called to the scene and
  the patient is transported to the nearest ED. En
  route, the patient suffers a generalized seizure.

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CASE 5

• A four year old child presents with new onset
  seizure activity and is admitted to a tertiary
  care PICU. After an extensive work-up, no clear
  etiologic cause is determined. One week after
  admission, a compulsive medical student questions
  the family and discovers the child had been
  force-fed dirt

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CASE 6

• A dermatology calls the toxicology service
  frantic stating his patient is actively seizing
  in his clinic. The patient had been undergoing
  an extensive hair transplant

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MANAGEMENT OF TOXIN OR DRUG-INDUCED SEIZURES
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MANAGEMENT

• 1. ABCs
• 2. Gastric Decontamination
• 3. Antidotes

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MANAGEMENT

• 4. Benzodiazepines
• 5. Phenobarbital
• 6. Phenytoin
• 7. Valproic Acid

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MANAGEMENT

• Neuromuscular paralysis

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TOXIC SEIZURES

• O - Organophosphates,
  
• Oral hypoglycemics
• T - Tricyclic Antidepressants, Theophylline
• I - INH, Insulin
• S - Salicylates, Sympathomimetics, Strychnine

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TOXIC SEIZURES

• C - Cocaine, Camphor,
• Carbon Monoxide
• A - Amphetamines, Anticholinergics
• M - Methyl Xanthines, Morels (False)
• P - Pesticides, Propoxyphene, PCP

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TOXIC SEIZURES

• B - Botanicals, Benzo withdrawal, Bioski
• E - Ethanol Withdrawal
• L - Lead, Lithium
• L - Lindane, Lidocaine

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Summary

• Many drugs and toxicologic agents can lower a
  patients seizure threshold resulting in seizure
  activity.
• Seizure activity may be the first clinical sign
  of a toxic exposure.

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Summary

• In general, benzodiazepines are the first line of
  treatment for toxin-induced seizures unless a
  specific antidote is available.
• Although phenytoin is the second-line agent
  indicated in the treatment of most causes of
  seizures, it is usually not efficacious in the
  management of drug-induced seizures.

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Summary

• When managing suspected toxin-induced seizures,
  it is imperative to not overlook coexisting head
  injuries, spinal injuries, rhabdomyolysis,
  infection, or hyperthermia.

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BIBLIOGRAPHY

• Bey T, Walter F Seizures. In Ford M, DeLaney K,
  Ling L, Erickson T Clinical Toxicology. WB
  Saunders Co, Philadelphia, 2001pp155-167.
• Kunisaki T, Augenstein W Drug and toxin-induced
  seizures. Emerg Med Clin North Am
  1994121027-1056.
• Olson K, Kearney T, Dyer J, et al Seizures
  associated with poisoning and drug overdose. Am J
  Emerg Med1994 12392-395.

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Questions?