External ophthalmoplegia, alpha and spindle coma in imipramine overdose: Case report and review of the literature

Abstract

A 13-year-old boy with imipramine overdose developed seizures, respiratory arrest, and coma. Abnormalities of oculovestibular reflexes, electroencephalograms, and brainstem auditory evoked potentials were monitored in relation to measurements of drug levels. An alpha-coma electroencephalographic pattern evolved into one evidencing spindle coma and eventually into a normal pattern. Prolonged brainstem auditory evoked potentials also normalized as coma and oculocephalic reflex abnormalities resolved. In spite of the history that suggested hypoxic damage, the absence of reflex eye movements in a comatose patient and the presence of alpha- and spindle-coma electroencephalographic patterns, even with prolonged brainstem auditory evoked potentials, are not reliable prognostic indicators in tricyclic drug overdose.

Rhythmic Coma in Children

“…However, the outcome may actually be more dependent on the etiology of the coma than on the electroencephalographic (EEG) findings.2 Only rare and scattered cases of alpha coma have been reported in the pediatric population. 1, [3][4][5][6][7][8][9] Etiologies included hypoxic-ischemic encephalopathy (cardiac arrest), hypoxia (strangulation and near drowning), metabolic and toxic derangements (Reye's syndrome and barbituate overdose), and head trauma (Table 1). Outcome in reported cases was varied; three survived and were normal neurologically, three survived with significant neurologic deficit, and three died.…”

Spindle Coma in the Intensive Care Unit: Different Aetiologies – Different Outcomes

“…Among drug intoxications, the most frequent are benzodiazepines and barbiturates, with only one case describing SC with tricyclic antidepressant overdose [5] , like that which occurred in our first case. The prognosis in cases of drug intoxications is favourable with adequate treatment, with SC reactivity having less value for outcome prediction [4] .…”

Spindle Coma in Benzodiazepine Toxicity: Case Report

“…4,8,16 Such a conclusion has been made by many authors on the basis of postmortem studies,7,17,18 computed tomoqraphy '-v'\r.Ar--""""",--""VJV'-..-.'\/'N'<-.r! 'VVVy""",,,,'~~/'Vc~-"~VV' 50 "vi "",,"' ne"' -;:-se"",:::,o"EEG taken 5 days after lorazepam was discontinued.…”