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Published on: May 16, 2019
[Clinical review on patients who developed seizures during theophylline administration: relationships with
Yasuhei Odajima1, Hiroshi Nakano, Tetsuji Kato
1Department of Pediatrics, Saitama Medical School. odajima@saitama-med.ac.jp
Insights
Theophylline-related seizures in children often occur in those with pre-existing neurological conditions like epilepsy. Fever, young age, and a history of seizures are key risk factors to consider when administering theophylline.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Adverse Drug Event Monitoring
Context:
- Theophylline is a medication used for respiratory conditions.
- Seizures during theophylline treatment are sometimes broadly labeled as theophylline-related.
- This study examines underlying factors in pediatric seizures during theophylline administration.
Purpose:
- To investigate background factors contributing to seizures in pediatric patients receiving theophylline.
- To differentiate between theophylline-induced seizures and seizures in patients with predisposing conditions.
Summary:
- A review of 255 oral and 79 IV theophylline adverse event cases in children revealed neurological predispositions (epilepsy, prior seizures) in over two-thirds of patients.
- These neurological factors were present in 90% of patients with severe outcomes (sequelae, death).
- Risk factors for seizures included fever, age under 3 years, and a history of seizures.
Impact:
- Highlights the importance of considering patient-specific neurological factors before attributing seizures solely to theophylline.
- Informs safer administration practices for theophylline in pediatric populations.
- Emphasizes the need for careful patient selection and monitoring in children with risk factors.
Objective:
In recent years, attempts have been made to broadly deem seizures developing during theophylline administration as theophylline-related seizures. Consequently, a tendency to consider all the seizures attributable to theophylline has occurred. We investigated background factors in pediatric patients with seizures to examine the involvement of theophylline in the event.
Methods:
Of adverse events developing during theophylline administration which were reported by two theophylline preparation manufacturers between October 1987 and April 2004, we investigated underlying disease, regimen, outcome, and other items in 255 patients with seizures provoked by oral preparations and in 79 patients with seizures provoked by intravenous preparations.
Results:
The most predominant factors were represented by neurological predispositions, e.g., epilepsy, and by a history of fits prior to the onset of seizures in not less than two-thirds of pediatric patients with seizures who were receiving theophylline. Furthermore, not less than 90% of pediatric patients who remained with sequelae and who died had the factors. Our investigation revealed that the factors developed predominantly when the relevant patients presented fever, aged under 3 years and had history of seizures.
Conclusions:
Therefore, we consider that advertence to this point is most important in administering theophylline safely.
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