olanzapine and Status-Epilepticus

A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology.

Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Autoantibodies; Benzodiazepines; Catatonia; Delayed Diagnosis; Diagnosis, Differential; Diagnostic Errors; Diazepam; Electroconvulsive Therapy; Emergencies; Epilepsies, Partial; Hallucinations; Humans; Infectious Encephalitis; Male; Methamphetamine; Olanzapine; Poisoning; Receptors, N-Methyl-D-Aspartate; Status Epilepticus; Young Adult

Few cases of seizures associated with olanzapine therapy and even fewer with mirtazapine have been published, most of them in patients with confounding risk factors. Our objective was to report a case of Status epilepticus in a patient receiving olanzapine and mirtazapine, with no previous history of seizure and no confirmed underlying cause for seizure.. A 48-year-old white, psychotic woman developed generalized tonic-clonic seizures that progressed to Status epilepticus during hospitalization. 4 days before the incident, mirtazapine (30 mg) was added to the treatment, while 2 days before the incident, the treatment switched from quetiapine to olanzapine, and mirtazapine was increased to 60 mg. No other toxic, metabolic, electrolyte or anatomic abnormality was identified. After discontinuation of olanzapine, the patient remained seizure-free.. To our knowledge, this is the second reported case of Status epilepticus that has been associated with the use of olanzapine, while only one report of seizures, but none of Status epilepticus connected to mirtazapine is found in the literature. Although olanzapine has infrequently been associated with epileptogenic risk, it should be used cautiously especially when concomitant medication or other predisposing factors exist.

Topics: Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Drug Interactions; Female; Humans; Mianserin; Middle Aged; Mirtazapine; Olanzapine; Psychotic Disorders; Status Epilepticus