Abstract
Paroxysmal nonepileptic events are episodic changes in behavior, sensation, or consciousness that are similar to epileptic seizures but not associated with abnormal ictal brain electrophysiological discharges. Here, a case treated as epileptic seizure was presented in order to draw attention to paroxysmal nonepileptic events in differential diagnosis.
A 4 years old girl sent to our hospital with the diagnose of status epilepticus due to change in her consciousness, contractions and abnormal movements in her body, arms and legs those started after taking 6 spoonfull syrup of Peditus® (Containing 120 mg paracetamol, 50 mg guaifenesin, 6.25 mg pyrilamine maleate, 5 mg phenylephrine hcl in 5 ml scale) and 5 Medikinet® 10 mg capsules (10 mg methylphenidate hydrochloride in 1 capsule). She was conscious and cooperate and has involuntary snake-like movements throughout her body on admission. The patient's movement disturbances thought as methylphenidate-induced choreoathetosis responded to given haloperidol treatment and any sign of poisoning were not observed in the patient's follow up.
Chorea side effects were observed in our patient but not any poisoning symptoms, who received a toxic dose of methylphenidate for her age. This suggests that methylphenidate, a central nervous system stimulant, may have therapeutic, toxic dose limits and side effects profile those associated with individual pharmacogenetic variations. Accurate distinction of chorea from drug-related paroxysmal nonepileptic events will ensure early effective treatment of patients and to protect patients from unnecessary drug risks.
Keywords
References
- 1. Wirrell EC, Grossardt BR, Wong-Kisiel LC, Nickels KC. Incidence and classification of new-onset epilepsy and epilepsy syndromes in children in Olmsted County, Minnesota from 1980 to 2004: a population-based study. Epilepsy Res. 2011;95(1-2):110-118.
- 2. Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A. Nonepileptic paroxysmal events in a pediatric population. Epilepsy Behav. 2010;17(2):272-275.
- 3. Ford JB, Albertson TE, Owen K, Sutter ME, McKinney B: Acute, sustained chorea in children after supratherapeutic dosing of amphetamine-derived medications. Pediatr Neurol. 2012;47:216-218.
- 4. Ghuman JK, Arnold LE, and Anthony BJ, "Psychopharmacological and Other Treatments in Preschool Children With Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice," J Child Adolesc Psychopharmacol, 2008;18(5):413-47.
- 5. Foley R, Mrvos R, Krenzelok EP: A profile of methylphenidate exposures. Clin Tox 2000, 38:625–630.
- 6. Lee J, Grizenko N, et all. Relation Between Therapeutic Response and Side Effects Induced by Methylphenidate as Observed by Parents and Teachers of Children With ADHD. BMC Psychiatry. 2011;21:11:70
- 7. Lopez W, Jeste DV: Movement disorders and substance abuse. Psychiatr Serv. 1997;48:634-636.
- 8. Melvin KE, Heiraty P. Acute chorea in a child after starting methylphenidate: a case report. Cureus. 2013;5(1):e90.
- 9. Rubia K, Alegria AA, Cubillo AI, Smith AB, Brammer MJ, Radua J. Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry. 2014;76:616–628.
- 10. Huang HC, Wu LS, Yu SC, et al. The Alpha-2A Adrenergic Receptor Gene -1291C/G Single Nucleotide Polymorphism is Associated with the Efficacy of Methylphenidate in Treating Taiwanese Children and Adolescents with Attention-Deficit Hyperactivity Disorder. Psychiatry Investig. 2018;15(3):306‐312.
- 11. Nemoda Z, Angyal N, Tarnok Z, Gadoros J, Sasvari-Szekely M. Carboxylesterase 1 gene polymorphism and methylphenidate response in ADHD. Neuropharmacology. 2009;57:731–733.
- 12. Serdyuk SE, Gmiro VE. Phenylephrine Potentiates the Anticonvulsant Effect and Neutralizes the Sedative Effect of Diazepam in Rats upon Combined Intragastric Administration. Bulletin of Experimental Biology and Medicine. 2014; 158(2):201-204
- 13. Keshavarz M, Showraki A, Emamghoreishi M. Anticonvulsant Effect of Guaifenesin against Pentylenetetrazol-Induced Seizure in Mice. Iran J Med Sci. 2013;38(2):116‐121.
- 14. Ford JB, Albertson TE, Owen KP, Sutter ME, McKinney WB. Acute, sustained chorea in children after supratherapeutic dosing of amphetamine-derived medications. Pediatr Neurol. 2012;47:216–218.
- 15. Ruha AM, Yarema MC. Pharmacologic treatment of acute pediatric methamphetamine toxicity. Pediatr Emerg Care. 2006;22:782–5
Abstract
Paroksismal nonepileptik olaylar, epileptik nöbetlere benzeyen ancak anormal iktal beyin elektrofizyolojik deşarjlarıyla ilişkili olmayan davranış, duyum veya bilinçteki epizodik değişikliklerdir. Burada epileptik nöbet düşünülerek tedavi verilmiş olan bir olgu ayrıcı tanıda paroksismal nonepileptik olaylara dikkat çekmek amacıyla sunuldu.
Dört yaşında kız çocuk 6 ölçek PeditusR şurup (5 ml ölçeğinde 120 mg parasetamol, 50 mg guaifenesin, 6,25 mg prilamin maleat, 5 mg fenilefrin hcl içeren) ve 5 adet Medikinet® 10 mg kapsülden (1 kapsülde 10 mg metilfenidat hidroklorür) içme sonrası gelişen bilincinde değişiklik, vücudunda, kol ve bacaklarında kasılmalar ve anormal hareketler olması nedeniyle status epileptikus ön tanısıyla hastanemize sevk edilmişti. Hastanın başvuruda bilinci açık, iletişimi normaldi ve tüm vücudunda istemsiz yılanvari hareketleri vardı. Metilfenidata bağlı koreatetoz düşünülerek yapılan haloperidol tedavisi sonrası hareket bozukluğu düzeldi ve hastanın izlemde zehirlenmeye ait başka bir bulgu gözlenmedi.
Yaşı için toksik dozda metilfenidat alan hastamızda zehirlenme belirtileri olmadan kore yan etkisi gelişmiştir. Bu durum bir santral sinir sistemi uyarıcısı olan metilfenidatın, terapötik ve toksik doz sınırlarının, yan etki profilinin, bireysel farmakogenetik çeşitlilikle ilişkili olabileceğini düşündürmektedir. İlaç ilişkili paroksismal nonepileptik olaylardan korenin doğru ayrımı hastaların erken etkin tedavisini ve gereksiz ilaç risklerinden korunmasını sağlayacaktır.
Keywords
References
- 1. Wirrell EC, Grossardt BR, Wong-Kisiel LC, Nickels KC. Incidence and classification of new-onset epilepsy and epilepsy syndromes in children in Olmsted County, Minnesota from 1980 to 2004: a population-based study. Epilepsy Res. 2011;95(1-2):110-118.
- 2. Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A. Nonepileptic paroxysmal events in a pediatric population. Epilepsy Behav. 2010;17(2):272-275.
- 3. Ford JB, Albertson TE, Owen K, Sutter ME, McKinney B: Acute, sustained chorea in children after supratherapeutic dosing of amphetamine-derived medications. Pediatr Neurol. 2012;47:216-218.
- 4. Ghuman JK, Arnold LE, and Anthony BJ, "Psychopharmacological and Other Treatments in Preschool Children With Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice," J Child Adolesc Psychopharmacol, 2008;18(5):413-47.
- 5. Foley R, Mrvos R, Krenzelok EP: A profile of methylphenidate exposures. Clin Tox 2000, 38:625–630.
- 6. Lee J, Grizenko N, et all. Relation Between Therapeutic Response and Side Effects Induced by Methylphenidate as Observed by Parents and Teachers of Children With ADHD. BMC Psychiatry. 2011;21:11:70
- 7. Lopez W, Jeste DV: Movement disorders and substance abuse. Psychiatr Serv. 1997;48:634-636.
- 8. Melvin KE, Heiraty P. Acute chorea in a child after starting methylphenidate: a case report. Cureus. 2013;5(1):e90.
- 9. Rubia K, Alegria AA, Cubillo AI, Smith AB, Brammer MJ, Radua J. Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry. 2014;76:616–628.
- 10. Huang HC, Wu LS, Yu SC, et al. The Alpha-2A Adrenergic Receptor Gene -1291C/G Single Nucleotide Polymorphism is Associated with the Efficacy of Methylphenidate in Treating Taiwanese Children and Adolescents with Attention-Deficit Hyperactivity Disorder. Psychiatry Investig. 2018;15(3):306‐312.
- 11. Nemoda Z, Angyal N, Tarnok Z, Gadoros J, Sasvari-Szekely M. Carboxylesterase 1 gene polymorphism and methylphenidate response in ADHD. Neuropharmacology. 2009;57:731–733.
- 12. Serdyuk SE, Gmiro VE. Phenylephrine Potentiates the Anticonvulsant Effect and Neutralizes the Sedative Effect of Diazepam in Rats upon Combined Intragastric Administration. Bulletin of Experimental Biology and Medicine. 2014; 158(2):201-204
- 13. Keshavarz M, Showraki A, Emamghoreishi M. Anticonvulsant Effect of Guaifenesin against Pentylenetetrazol-Induced Seizure in Mice. Iran J Med Sci. 2013;38(2):116‐121.
- 14. Ford JB, Albertson TE, Owen KP, Sutter ME, McKinney WB. Acute, sustained chorea in children after supratherapeutic dosing of amphetamine-derived medications. Pediatr Neurol. 2012;47:216–218.
- 15. Ruha AM, Yarema MC. Pharmacologic treatment of acute pediatric methamphetamine toxicity. Pediatr Emerg Care. 2006;22:782–5
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | March 18, 2021 |
| Submission Date | August 28, 2020 |
| Published in Issue | Year 2021 Volume: 12 Issue: 1 |
