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Amitriptyline-associated seizures in a toddler with Munchausen-by-proxy
M E Mullins1, C B Cristofani, C R Warden
1Oregon Poison Center and Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201-3098, USA. mullinmi@ohsu.edu
Pediatric Emergency Care
|July 2, 1999
Summary
A toddler
Area of Science:
- Pediatric Neurology
- Clinical Toxicology
Background:
- Idiopathic seizures are common in toddlers.
- Accurate diagnosis is crucial for appropriate treatment.
Observation:
- A toddler presented with recurrent seizures, initially diagnosed as idiopathic epilepsy.
- Electrocardiogram (EKG) showed widened QRS and right axis deviation.
- Despite multiple admissions, the cause remained undiagnosed.
Findings:
- The seizures were deliberately induced by amitriptyline poisoning administered by a custodian.
- Classic signs of cyclic antidepressant poisoning were overlooked.
- Misdiagnosis was facilitated by the assumption of epilepsy in patients with seizures.
Implications:
- Highlights the importance of considering toxicological causes in unexplained seizures, even with a prior epilepsy diagnosis.
- Underscores the need for thorough investigation of cyclic antidepressant poisoning.
- Emphasizes the diagnostic challenges posed by non-accidental poisoning in pediatric patients.