Status epilepticus theophylline

Phenobarbital Enhances phasic GABAa receptor responses reduces excitatory synaptic responses Nearly complete absorption not significantly bound to plasma proteins peak concentrations in Vi to 4 h no active metabolites tjy2 varies from 75 to 125 h Generalized tonic-clonic seizures, partial seizures, myoclonic seizures, generalized seizures, neonatal seizures, status epilepticus Toxicity Sedation, cognitive issues, ataxia, hyperactivity Interactions Valproate, carbamazepine, felbamate, phenytoin, cyclosporine, felodipine, lamotrigine, nifedipine, nimodipine, steroids, theophylline, verapamil, others... 

Hemodialysis or hemoperhision should be performed if the patient is in status epilepticus or if the serum theophylline concentration is greater than 100 mg/L. 

A. Control of tonic-clonic seizures and status epilepticus, generally as a seconder third-line agent after diazepam or phenytoln have been tried. Note For treatment of dmg-Induced seizures, especially seizures caused by theophylline, phenobarbital Is often tried before phenytoln. 

Nervous system Status epilepticus has been attributed to theophylline in two cases. 

A 5-year-old boy with no history of convulsions had a generalized tonic-clonic seizure after taking oral theophylline for 2 days followed by non-convulsive status epilepticus [95 ]. The serum theophylline concentration was 19.7 mg/1. An intravenous bolus dose of midazolam 0.26 mg/kg largely restricted seizure activity to the right hemisphere and another 0.24 mg/kg followed by a continuous infusion of 0.20 mg/kg/hour completely abolished the electrical status. 

An 8-month-old boy who had been given oral modifled-release theophylline and additional aminophylline suppositories developed convulsive status epilepticus [96 ]. A combination of diazepam, lidocaine, and thiopental was required to stop the convulsion. A pharmacokinetic study showed that the use of the mod-ified-release formula would have given a plasma concentration of no more than 15 mg/ 1, but that the addition of aminophylline would have increased it to over 20 mg/1. 

Nobutoki T, Takahashi JY, Ihara T. A 5-year-old boy with nonconvulsive status epilepticus induced by theophylline treatment. No To Hattatsu 2008 40(4) 328-32. 

Kato Z, Yamagishi A, Nakamura M, Kondo N. Theophylline-associated status epilepticus in an infant pharmacokinetics and the risk of suppository use. World J Pediatr 2009 5(4) 316-8. 

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