[Nonconvulsive Status Epilepticus Associated with Theophylline: A Case Report]

Area of Science:

• Neurology
• Pharmacology
• Internal Medicine

Background:

• An 87-year-old female patient with a history of asthma, cerebral infarction, and convulsive status epilepticus presented with speech disturbance and facial neurological deficits.
• She was on theophylline, levetiracetam, and clopidogrel for her pre-existing conditions.

Observation:

• Diffusion-weighted MRI revealed a lesion in the left posterior internal capsule.
• The patient experienced tonic-clonic convulsions after initiating cilostazol.
• Seizures worsened despite dose adjustments of levetiracetam and addition of lacosamide.

Findings:

• Discontinuation of theophylline, with a blood concentration of 9.7μg/mL, led to the improvement of tonic-clonic convulsions.
• Neurological deficits, including consciousness disturbance, hemiparesis, and sensory aphasia, gradually resolved over weeks to a month.
• Theophylline toxicity is suspected to have caused or exacerbated central nervous system damage, potentially leading to aminophylline-related non-convulsive status epilepticus.

Implications:

• This case highlights the critical need to monitor theophylline levels in elderly patients, especially those with a history of cerebrovascular events.
• It underscores the potential neurotoxic effects of theophylline and the importance of considering drug interactions and patient comorbidities in managing neurological symptoms.
• The findings suggest that theophylline toxicity can precipitate severe seizures and neurological deficits, necessitating prompt recognition and management.