Drug-induced seizures in children and adolescents presenting for emergency care: Current and emerging trends

Y. Finkelstein, J. R. Hutson, S. B. Freedman, P. Wax, J. Brent

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Context. Seizures may be the presenting manifestation of acute poisoning in children. Knowledge of the etiologic agent, or likely drug-class exposure, is crucial to minimize morbidity and optimize care. Objectives. To describe the agents most commonly responsible for pediatric drug-induced seizures, whose evaluation included a medical toxicology consultation in the United States. Methods. Using the 37 participating sites of the Toxicology Investigators Consortium (ToxIC) Case Registry, a cross-country surveillance tool, we conducted an observational study of a prospectively collected cohort. We identified all pediatric (younger than 18 years) reports originating from an Emergency Department (ED) which included a chemical or drug-induced seizure, and required a medical toxicology consultation between April 1, 2010 and March 31, 2012. Results. We identified 142 pediatric drug-induced seizure cases (56% male), which represent nearly 5% of pediatric cases requiring bedside consultation by medical toxicologists. One-hundred and seven cases (75%) occurred in children aged 13-18 years, and 86 (61%) resulted from intentional ingestions. Antidepressants were the most commonly identified agents ingested (n = 61; 42%), of which bupropion was the leading drug (n = 30; 50% of antidepressants), followed by anticholinergics/antihistamines (n = 31; 22%). All antidepressant-induced seizures in teenagers were intentional and represented self-harm behavior. Sympathomimetic agents, including street drugs, represent the most common agents in children younger than 2 years (n = 4/19). Conclusion. Antidepressants, and specifically bupropion, are presently the most common medications responsible for pediatric drug-induced seizures requiring medical toxicology consultation in the United States. In teenagers presenting with new-onset seizures of unknown etiology, the possibility of deliberate self-poisoning should be explored, since most drug-induced seizures in this age group resulted from intentional ingestion.

Original languageEnglish (US)
Pages (from-to)761-766
Number of pages6
JournalClinical Toxicology
Volume51
Issue number8
DOIs
StatePublished - Sep 2013

Fingerprint

Emergency Medical Services
Pediatrics
Seizures
Antidepressive Agents
Pharmaceutical Preparations
Toxicology
Referral and Consultation
Bupropion
Poisoning
Eating
Sympathomimetics
Histamine Antagonists
Cholinergic Antagonists
Street Drugs
Observational Studies
Registries
Hospital Emergency Service
Age Groups
Research Personnel
Morbidity

Keywords

  • Convulsions
  • Emergency medicine
  • Pediatrics
  • Poisoning
  • Registry

ASJC Scopus subject areas

  • Toxicology

Cite this

Drug-induced seizures in children and adolescents presenting for emergency care : Current and emerging trends. / Finkelstein, Y.; Hutson, J. R.; Freedman, S. B.; Wax, P.; Brent, J.

In: Clinical Toxicology, Vol. 51, No. 8, 09.2013, p. 761-766.

Research output: Contribution to journalArticle

Finkelstein, Y. ; Hutson, J. R. ; Freedman, S. B. ; Wax, P. ; Brent, J. / Drug-induced seizures in children and adolescents presenting for emergency care : Current and emerging trends. In: Clinical Toxicology. 2013 ; Vol. 51, No. 8. pp. 761-766.
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abstract = "Context. Seizures may be the presenting manifestation of acute poisoning in children. Knowledge of the etiologic agent, or likely drug-class exposure, is crucial to minimize morbidity and optimize care. Objectives. To describe the agents most commonly responsible for pediatric drug-induced seizures, whose evaluation included a medical toxicology consultation in the United States. Methods. Using the 37 participating sites of the Toxicology Investigators Consortium (ToxIC) Case Registry, a cross-country surveillance tool, we conducted an observational study of a prospectively collected cohort. We identified all pediatric (younger than 18 years) reports originating from an Emergency Department (ED) which included a chemical or drug-induced seizure, and required a medical toxicology consultation between April 1, 2010 and March 31, 2012. Results. We identified 142 pediatric drug-induced seizure cases (56{\%} male), which represent nearly 5{\%} of pediatric cases requiring bedside consultation by medical toxicologists. One-hundred and seven cases (75{\%}) occurred in children aged 13-18 years, and 86 (61{\%}) resulted from intentional ingestions. Antidepressants were the most commonly identified agents ingested (n = 61; 42{\%}), of which bupropion was the leading drug (n = 30; 50{\%} of antidepressants), followed by anticholinergics/antihistamines (n = 31; 22{\%}). All antidepressant-induced seizures in teenagers were intentional and represented self-harm behavior. Sympathomimetic agents, including street drugs, represent the most common agents in children younger than 2 years (n = 4/19). Conclusion. Antidepressants, and specifically bupropion, are presently the most common medications responsible for pediatric drug-induced seizures requiring medical toxicology consultation in the United States. In teenagers presenting with new-onset seizures of unknown etiology, the possibility of deliberate self-poisoning should be explored, since most drug-induced seizures in this age group resulted from intentional ingestion.",
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