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Infantile spasms associated with theophylline toxicity
M D Shields1, E M Hicks, D F Macgregor
1Royal Belfast Hospital for Sick Children, Northern Ireland.
Insights
A 6-month-old infant experienced infantile spasms and abnormal EEG results linked to theophylline treatment for asthma. Symptoms resolved after discontinuing theophylline, suggesting a causal relationship.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Asthma Management
Background:
- Asthma is a common chronic respiratory disease in infants.
- Theophylline is a bronchodilator sometimes used in asthma treatment.
- Infantile spasms are a severe form of epilepsy in infants.
Observation:
- A 6-month-old infant with asthma developed spasms and hypsarrhythmia on electroencephalogram (EEG).
- These symptoms emerged shortly after initiating oral theophylline.
- Theophylline levels were slightly elevated, just above the normal range.
Findings:
- Discontinuation of theophylline led to the cessation of spasms.
- EEG normalization occurred after theophylline withdrawal and initiation of nitrazepam.
- The infant exhibited normal neurodevelopment over a 3-year follow-up period.
Implications:
- Theophylline toxicity may precipitate infantile spasms in susceptible infants.
- Careful monitoring of theophylline levels and potential neurological side effects is crucial.
- Prompt recognition and management can lead to favorable neurodevelopmental outcomes.
Abstract:
We report on a 6-month-old infant with asthma who developed spasms and hypsarrhythmia on the electroencephalogram (EEG) shortly after starting oral theophylline medication. Theophylline levels at that time were just above the upper normal range. The spasms stopped and the EEG normalized when theophylline was discontinued and nitrazepam therapy started. On follow-up over the next 3 years there was no recurrence of seizures and the child's neurodevelopment has been normal. Nitrazepam was stopped at 10 months and the waking and sleeping EEG were normal at 14 months. We believe that the infantile spasms were caused by theophylline.