quetiapine-fumarate and Status-Epilepticus

We report about a patient (66 years) who was referred to our psychiatric hospital because of a progressive confusional state with acute onset. The colleagues of the referring psychiatric hospital considered a first manic episode as the cause of the symptoms and under therapy with haloperidol the confusional state had shown a progression.The clinical examination's findings were a mild central facial paresis on the right side and a mild hemiparesis on the right side with elevated reflex levels.The patient was disoriented, he had cognitive and mnestic deficits. His reasoning was slowed, incoherent and perseverating. The patient had a slight euphoria.An EEG recording showed a continuous regional EEG-seizure pattern. In combination with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment with Topiramate symptoms ameliorated but due to a vascular dementia the patient still showed fluctuating symptoms of cognitive and mnestic disturbances.

Topics: Affect; Aged; Anticonvulsants; Antipsychotic Agents; Brain Edema; Confusion; Delirium; Dibenzothiazepines; Drug Substitution; Drug Therapy, Combination; Electroencephalography; Frontal Lobe; Fructose; Humans; Lorazepam; Magnetic Resonance Imaging; Male; Mental Status Schedule; Neurologic Examination; Quetiapine Fumarate; Referral and Consultation; Signal Processing, Computer-Assisted; Status Epilepticus; Topiramate; Valproic Acid

Electroconvulsive therapy (ECT) is indicated for the treatment of severe treatment refractory depression in many countries. It is associated with a low risk of morbidity and mortality. It is usual for high doses of psychotropic medications to be prescribed concomitantly with ECT, although published data on the interactions of these with ECT is lacking. Here, we present the case of a middle-aged woman on multiple psychotropic medications who went into status epilepticus for 45 minutes after ECT.

Topics: Affect; Antidepressive Agents; Antidepressive Agents, Tricyclic; Antimanic Agents; Antipsychotic Agents; Clomipramine; Combined Modality Therapy; Depressive Disorder, Major; Dibenzothiazepines; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Lithium Compounds; Middle Aged; Quetiapine Fumarate; Recurrence; Status Epilepticus; Thyroxine; Tryptophan