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First-line therapy for theophylline-associated seizures
1Department of Neurology, Miyagi Children's Hospital, Sendai, Miyagi, Japan. hideto@miyagi-children.or.jp
Acta Neurologica Scandinavica
|March 17, 2007
Summary
Theophylline-associated seizures (TAS) are a neurologic emergency. Barbiturates are recommended over diazepam for treating TAS when initial treatments fail, to prevent brain injury.
Area of Science:
- Neurology
- Pharmacology
Background:
- Theophylline-associated seizures (TAS) are a serious neurologic emergency.
- Standard treatments like intravenous diazepam are often ineffective for TAS.
- Status epilepticus from theophylline may necessitate endotracheal intubation.
Purpose of the Study:
- To investigate the optimal first-line therapy for theophylline-associated seizures.
- To compare the characteristics and treatment outcomes of TAS versus non-TAS.
Main Methods:
- A retrospective study comparing 54 cases of TAS with 779 cases of non-TAS.
- Data collected from a single institution between 1991 and 2002.
- Review of existing literature on TAS therapy.
Main Results:
- TAS primarily affects children under 3 years old, with seizures often occurring at therapeutic theophylline levels.
- Diazepam was less effective in controlling TAS (45%) compared to non-TAS (68%).
- 27% of TAS cases required endotracheal intubation, indicating treatment intractability.
Conclusions:
- Theophylline may antagonize benzodiazepine effects, explaining diazepam's lower efficacy in TAS.
- Prompt use of barbiturates is recommended when diazepam is ineffective for TAS.
- Early intervention with appropriate therapy is crucial to prevent potential brain injury from status epilepticus.
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