Drug-related seizures

Question 1

What are types of drugs which can cause seizures?

Answer 1

1. Benzodiazepines
2. GHB - recreational drug
3. Legal highs - novel psychoactive substances
4. SSRIs: serotonin syndrome
5. Amphetamine-like agents

Question 2

When can benzodiazepines cause seizures?

Answer 2

withdrawal syndrome - seizures and delirium can occur

Question 3

What are 4 types of drugs which can cause serotonin syndrome?

Answer 3

1. Monoamine oxidase inhibitors
2. SSRIs
3. Ecstasy
4. Amphetamines

Question 4

What drug can interact with SSRIs to cause serotonin syndrome?

Answer 4

St John’s Wort (often taken over the counter for depression)

Question 5

What are 6 key features of serotonin syndrome?

Answer 5

1. Neuromuscular excitation e.g. hyperreflexia, myoclonus, rigidity
2. Autonomic nervous system excitation e.g. hyperthermia, diaphoresis, tremor
3. Altered mental state
4. Seizures
5. Fever
6. Diarrhoea

Question 6

What are 3 neuromuscular excitation features of serotonin syndrome?

Answer 6

1. Hyperreflexia
2. Myoclonus
3. Rigidity

Question 7

What are 4 autonomic nervous system excitation features of serotonin syndrome?

Answer 7

1. Hyperthermia
2. Tremor
3. Diaphoresis
4. Dilated pupils

Question 8

What are 3 findings on the vital signs of a patient with serotonin syndrome?

Answer 8

1. pyrexia
2. tachycardia
3. raised BP

Question 9

Over what time frame does serotonin syndrome develop?

Answer 9

hours

Question 10

What are 2 broad aspects of the management of serotonin syndrome?

Answer 10

1. IV fluids
2. Benzodiazepines

Question 11

What are 2 drugs which can be used to manage severe cases of serotonin syndrome?

Answer 11

1. Cyproheptadine
2. Chlorpromazine