[Theophylline-associated epilepsy with lacuna infarction]

Area of Science:

• Neurology
• Pediatric Neurology
• Neurophysiology

Background:

• Theophylline is a medication used to treat respiratory diseases.
• Theophylline overdose can lead to serious neurological complications, including seizures.
• Status epilepticus is a medical emergency characterized by prolonged or recurrent seizures.

Observation:

• A 9-year-old boy presented with new-onset complex partial seizures.
• The patient had a history of theophylline-associated convulsive status epilepticus 4 years and 7 months prior.
• Ictal electroencephalogram (EEG) showed abnormal theta wave bursts without a superficial focus, suggesting a deep brain origin.
• Magnetic Resonance Imaging (MRI) revealed left thalamic infarction and hippocampal sclerosis.

Findings:

• The patient's complex partial seizures were linked to the prior theophylline-induced status epilepticus.
• Deep brain abnormalities, specifically left thalamic infarction and hippocampal sclerosis, were identified as potential causes.
• The EEG findings supported the presence of a deep-seated epileptic focus.

Implications:

• This case highlights the potential for long-term neurological sequelae following theophylline-associated convulsive status epilepticus in children.
• It underscores the importance of neuroimaging and EEG in evaluating new-onset seizures in patients with a history of status epilepticus.
• Understanding the long-term effects of theophylline toxicity is crucial for pediatric neurology and patient management.