Worsening of status epilepticus by benzodiazepines?
Hello everyone,
I need help with a case study.
The situation is as follows:
An 18-year-old patient presents to the hospital. He reports an aura with known seizure disorders. Initial vital signs reveal:
-147bpm
– 130/70 mmHg
-98% spO2
-113 bz
-Temperature is 39°C measured in the ear
– 25 AF
In the further anamnesis, the patient reports that he is taking Trileptal, ivabradine and Metropole and that the last seizure occurred 1 month ago.
During the further examination, the patient suddenly twists his arms in a tonic spasm which stops after about 30 seconds and turns into a tonic-clonic seizure 2 minutes later.
When asked about this, the patient's companion denied alcohol or drug consumption. The companion reported that the patient had been taking Cotrim for three days and that lidocaine cream had been applied to both elbows and the backs of both hands for a blood draw.
After administering 10 mg of midazolam intravenously, the patient stops having seizures for approximately 10 minutes before resuming a tonic-clonic seizure. A second dose of 10 mg of midazolam causes another pause of approximately 10 minutes. Despite repeated administration of various benzodiazepines and anticonvulsants, the seizures only seem to intensify. Even after repeated administration of propionate, the seizures do not abate.
My question is whether the increase in seizures could have something to do with the medication or whether the condition could also have been triggered by the fever.
Thanks in advance for answers
(1 votes)
Loading...
Interesting detailed description for an alleged “fictitious event”.
The patient is 18 years old and already takes medicines against seizures (trileptal), against a stapile and chronic AP as well as heart failure (Ivabradin) AND Metropolol as beta blocker?
Interesting medication for an 18-year-old…
I would not be aware that benzos can trigger or amplify a seizure, otherwise they would not be given. I simply assume that Levetiracetam (means of choice) has also been used to break the cramp. The cotrim and the licoainsalbe should have no influence.
For me, it sounds more like the patient or his colleagues are hiding something. A fall was not reported, so that a cerebral bleeding should also be excluded.
He is definitely too old for a fever cramp and he would have broken through.
In doubt, only intubation and general anaesthesia remains, even under the administration of muscle relaxation. This should stop the cramps.
Everything else is then “problem” of the neurologist.
Okay, thanks. The detalized description comes from a case actually happened only not happened to me, but it was reported to me. But there have been questions that I could not solve on my own or where I wanted to hear from others. Fiktiv was really not the case.
Not all case examples are fictive they can also really have happened and later be used as a case example. This example is a real case that has been reported to me so and has raised my question
The cause cannot be determined here. There are doctors, imaging diagnostics and laboratories… I’m thinking more about something being secreted.