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Toxicological seizures: characteristics, outcomes and recurrence.
Kristy McCulloch1,2, Ingrid Berling3, Angela L Chiew4
1Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.
Clinical Toxicology (Philadelphia, Pa.)
|September 4, 2025
Summary
Toxicological seizures from drug overdose are common, especially with tramadol and cocaine. Many patients experience seizure recurrence or develop epilepsy, requiring rigorous follow-up.
Area of Science:
- Clinical Toxicology
- Neuroscience
- Pharmacology
Background:
- Seizures are a critical indicator of severe toxicity following drug overdose.
- Limited research exists on the characteristics of toxicological seizures, their causes, and recurrence patterns.
Purpose of the Study:
- To investigate toxicological seizures in patients presenting with drug overdose.
- To identify the causative agents associated with these seizures.
- To determine the frequency of seizure recurrence and subsequent epilepsy diagnosis.
Main Methods:
- Retrospective observational study of patients with drug overdose-induced seizures.
- Data collected from three Australian clinical toxicology units (2014-2022).
- Analysis included patient demographics, causative agents, seizure characteristics, and follow-up data.
Main Results:
- 284 seizure presentations (275 patients) occurred over nine years.
- Common proconvulsant agents included tramadol, 3,4-methylenedioxymetamfetamine, and quetiapine.
- Seizure recurrence was observed in 20% of patients, with 4% diagnosed with epilepsy.
Conclusions:
- Toxicological seizures are frequently associated with specific drugs like tramadol, cocaine, and synthetic cannabinoid receptor agonists.
- A significant proportion of patients experience seizure recurrence or develop epilepsy post-overdose.
- Rigorous investigation, management, and follow-up of toxicological seizures are crucial, similar to unprovoked seizures.
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