Abstract:
:Myoclonic status epilepticus (MSE) in patients without epilepsy, or de novo MSE, is a rare condition associated with several acute symptomatic etiologies, including drugs and toxins. We describe a 94-year-old woman with Alzheimer dementia and long use of mirtazapine 30 mg/d and alprazolam 1 mg/d who developed MSE approximately 24 hours after abrupt discontinuation of alprazolam. The patient was taking sulfamethoxazole/trimethoprim for urinary tract infection, diagnosed 2 weeks before admission. She had no history of seizures. Routine laboratory examinations were normal and head computed tomography showed no acute injuries. She received a loading dose of 1000 mg of intravenous valproate (VPA). Continuous electroencephalogram monitoring revealed very frequent generalized spikes and polyspikes in a markedly slowed background activity. Intravenous VPA 500 mg thrice a day and alprazolam 0.5 mg twice a day were prescribed, and antibiotic was switched to piperacillin/tazobactam. Myoclonic jerks ceased completely and electroencephalogram showed no epileptiform discharges 2 days after VPA treatment onset, with recovery of baseline neurological status. This is, to the best of our knowledge, the first report of de novo MSE related to abrupt discontinuation of benzodiazepines. Seizures and status epilepticus are potential adverse events after abrupt withdrawal of chronically used benzodiazepines, especially in conditions with intrinsic epileptogenic susceptibility, such as Alzheimer disease.
journal_name
Clin Neuropharmacoljournal_title
Clinical neuropharmacologyauthors
Vicente Ferreira Naves P,Calderaro M,Caboclo LOdoi
10.1097/WNF.0000000000000283subject
Has Abstractpub_date
2018-07-01 00:00:00pages
142-144issue
4eissn
0362-5664issn
1537-162Xjournal_volume
41pub_type
杂志文章abstract::This article outlines the reasons that detection of subtle changes in the cognitive system is difficult in geriatric assessment. A new assessment approach is introduced that examines cognitive patterns and facilitates the evaluation of subtle changes. ...
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