A rare complication of a common stress test

Area of Science:

• Pharmacology
• Neurology
• Cardiology

Background:

• Regadenoson, a selective adenosine A2A receptor agonist, is FDA-approved for pharmacologic stress in myocardial perfusion studies.
• It increases coronary blood flow and is favored for its tolerability and ease of administration compared to adenosine.
• Adenosine receptors are widespread, mediating various physiological effects and potential adverse events.

Observation:

• While known adverse effects include bronchospasm, atrioventricular block, and hypotension, central nervous system effects are rarely reported.
• Adenosine receptors (A1 and A2A) are involved in neuron-glial cell interactions.
• A case of regadenoson-associated seizure is presented, highlighting a rare but serious adverse effect.

Findings:

• Regadenoson can provoke seizures via central A2A receptor activation.
• This mechanism involves the role of adenosine receptors in neuron-glial cell interactions.
• The study reports a specific case and reviews the underlying seizure mechanism.

Implications:

• Clinicians should consider the potential for seizures as a rare adverse effect of regadenoson.
• Patient selection for cardiac stress modalities should account for seizure risk, especially in those with a history of seizures or brain disease.
• Increased awareness of this rare central nervous system adverse effect is crucial for safe clinical practice.