Theophylline-induced seizures: clinical and pathophysiologic aspects

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Theophylline, a medication with a narrow therapeutic index, can cause serious adverse effects, including seizures.
• Understanding the specific clinical presentation and management of theophylline-induced seizures is crucial for timely intervention.

Observation:

• Theophylline-induced seizures typically occur in patients without prior neurological deficits.
• These seizures often present as focal motor seizures, potentially progressing to secondary generalization.
• A characteristic feature is the subsequent development of stupor or coma.

Findings:

• Seizure activity is primarily responsive to theophylline dosage adjustment.
• Persistent motor phenomena may manifest as epilepsia partialis continua.
• Extensive neuroimaging for structural lesions is often unrevealing.
• Electroencephalogram (EEG) findings frequently include periodic lateralized epileptiform discharges, serving as a diagnostic clue.

Implications:

• Prompt recognition and management of theophylline toxicity can prevent permanent neurological sequelae.
• The unique EEG patterns associated with these seizures aid in diagnosis.
• This highlights the importance of therapeutic drug monitoring for theophylline to avoid toxicity.