[A woman in her 50s with obesity, multimorbidity and seizures].

Area of Science:

• Neuroscience
• Pharmacology
• Clinical Medicine

Background:

• Obesity prevalence necessitates increased use of weight-loss medications.
• Potential adverse effects and drug interactions require clinical vigilance.
• Unexplained symptoms in patients warrant thorough investigation of medication side effects.

Purpose of the Study:

• To report a case of serotonin syndrome and status epilepticus in a patient using weight-loss and anxiety medications.
• To highlight the potential neurotoxic effects of bupropion/naltrexone and escitalopram combinations.
• To underscore the importance of recognizing drug-induced conditions in clinical practice.

Main Methods:

• Case report detailing a patient's presentation, treatment, and recovery.
• Review of patient's medication history, including bupropion/naltrexone and escitalopram.
• Diagnostic workup including EEG, CT, MRI, and lumbar puncture to exclude other causes.
• Initiation of specific treatments for serotonin syndrome and status epilepticus.

Main Results:

• Patient experienced generalized tonic-clonic seizure progressing to status epilepticus.
• Symptoms consistent with serotonin syndrome (agitation, rigidity, hyperthermia, hypertension) developed.
• No infectious or alternative neurological causes were identified.
• Patient recovered fully after treatment with cooling, sedation, and cyproheptadine.

Conclusions:

• Bupropion and escitalopram are associated with increased seizure risk and serotonin syndrome.
• Valproate may potentiate serotonin syndrome by affecting serotonin activity and bupropion metabolism.
• This case underscores the critical need for awareness of potential severe adverse events from combined psychotropic and weight-loss medications.