First-line therapy for theophylline-associated seizures

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Theophylline-associated seizures (TAS) are a critical neurologic emergency.
• Standard treatments like intravenous diazepam are often ineffective for TAS, sometimes necessitating endotracheal intubation.
• Optimal first-line therapy for TAS remains under investigation.

Purpose of the Study:

• To compare the characteristics and treatment outcomes of theophylline-associated seizures (TAS) with non-TAS.
• To evaluate the efficacy of diazepam in managing TAS.
• To review existing literature on TAS therapy.

Main Methods:

• A retrospective analysis comparing 54 cases of TAS with 779 cases of non-TAS from a single institution (1991-2002).
• Analysis included seizure types, patient demographics, serum theophylline levels, seizure duration, and treatment responses.
• Literature review on TAS therapeutic strategies.

Main Results:

• TAS predominantly affected children under 3 years old, with 78% having therapeutic serum theophylline levels.
• Diazepam was less effective in controlling TAS (45%) compared to non-TAS (68%), often requiring repeat doses.
• 27% of TAS cases required endotracheal intubation, and TAS duration was longer than non-TAS.

Conclusions:

• Theophylline may antagonize benzodiazepine effects, explaining diazepam's limited efficacy in TAS.
• Prompt use of barbiturates is advised when diazepam is ineffective for TAS.
• Early intervention with appropriate anticonvulsants is crucial to prevent potential brain injury from status epilepticus in TAS.