| Abstract [eng] |
Author: Kęstutis Meščeriakovas Title: Mechanisms of Drug-Induced Seizures: Literature Review and Case Studies Relevance: Seizures are an adverse reaction to a drug. It is caused by a wide variety of inborn as well as acquired abnormalities that alter the metabolism of drugs in the body. Recognizing a drug-induced seizure in a clinical environment is difficult due to the similarity to other causes of seizures and the sparse knowledge held about drug induced seizures in particular. Aim: To analyze the frequency, risk factors and mechanisms of drug induced seizures in the context of our clinical cases and scientific literature. Results: The frequency of drug induced seizures ranges from 0,1% to 23,5% depending on the drug, the dose administered, the way it was administered and the patients general health and other risk factors. There are several drug-induced seizure mechanisms: the disruption of the GABA-glutamate neurotransmitter balance and the inhibition of GABA’s inhibitory response, direct drug toxicity to brain tissue, electrolyte imbalance, genetic predisposition and gene polymorphism, in addition to drug cessation and related acute abstinence syndromes. From the case reports reviewed in this article it is evident that drugs can provoke or stimulate seizure activity. Conclusions and recommendations: Seizures are a rare adverse reaction to a drug the risk of which stems from various factors. It is difficult to identify drug-induced seizures in the clinical setting and a thorough assessment of the patient’s prior medical history is necessary for differential diagnosis. Drugs can act both as a provoking and stimulating agent for seizures. The most common mechanism by which drugs induce seizures is the disruption of the GABA-glutamate neurotransmitter balance. When presented with a patient experiencing seizures, a neurologist should not discount the possibility of drug-induced seizures and take time to analyze the possible risk factors and, if needed, consult with a clinical pharmacologist to discuss possible drug interactions and the effects of organic pathologies on the metabolism of medications. |
