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Acute zonisamide overdose: a death revisited.

Matthew D Sztajnkrycer1, E E Huang, G R Bond

  • 1Department of Pediatrics, Drug and the Poison Information Center, Children's Hospital Medical Center, Cincinnati, OH, USA.

Veterinary and Human Toxicology
|June 5, 2003
PubMed
Summary

Zonisamide overdose is rare, but a case report details seizures, cardiac arrest, and brain death in an 18-year-old woman after ingesting 4.8g. Other substances complicated the final cause of death determination.

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Area of Science:

  • Pharmacology
  • Toxicology
  • Neurology

Background:

  • Limited data exists on zonisamide (ZNS) overdose toxicity.
  • Zonisamide is an anti-epileptic agent used to treat seizures.

Observation:

  • An 18-year-old female ingested 4.8g of zonisamide in a suicide attempt.
  • The patient presented with generalized tonic-clonic seizures, airway secretions, and cardiopulmonary arrest.
  • Cerebral edema and tonsillar herniation were observed on CT scan, leading to confirmed brain death.

Findings:

  • Serum zonisamide levels were 44 mg/L.
  • The county coroner ruled the death secondary to zonisamide overdose.
  • Urine drug screen revealed mirtazepine, diphenhydramine metabolites, and caffeine, presenting confounding factors.

Implications:

  • This case highlights potential severe toxicity of zonisamide at supratherapeutic doses.
  • Confounding factors from co-ingested substances complicate definitive causality assessment.
  • Further research is needed to fully understand zonisamide overdose management and outcomes.

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