Late-onset seizures associated with quetiapine poisoning

Abstract

Introduction: Quetiapine, a second-generation antipsychotic, acts at multiple brain neurotransmitter receptors and has the potential for serious complications. Although seizures have been described in the literature, delayed seizure onset has not been reported. We report the first case of delayed seizures after a significant quetiapine overdose.Case Report: A 27-year-old female presented to the emergency department following an overdose of approximately 30 g of quetiapine. Twenty-four hours after arrival, the patient had 2 seizures. The patient was then intubated and remained in the ICU for four days. EEG was negative for epileptiform activity. The serum quetiapine levels (MedTox, St. Paul, MN) were 8.67 mg/L on hospital day one and 3.28 mg/L on hospital day three.Discussion: Quetiapine poisoning, with serum levels, associated with seizures has been reported in one prior case. Our case report represents late-onset seizures with serum levels above therapeutic range (>1 mg/L). The serum concentrations of quetiapine in this case were consistent with those in postmortem case reports. Toxicology Observations

Association Between Antipsychotic Treatment and Neurological Adverse Events in Pediatric Patients: A Population-Based Cohort Study in Korea

“…Among atypical antipsychotic agents, risperidone showed a clear dose-response relationship with the risk of developing movement disorders (31), and olanzapine and ziprasidone were associated with risk of developing movement disorders (particularly akathisia) at higher doses (32). Likewise, the dose effect of antipsychotics on seizure incidence has been reported previously (33)(34)(35)(36)(37). For instance, clozapine exhibited a clear dose-response relationship in the increased risk of developing seizures.…”

“…Olanzapine was generally known to be associated with a higher seizure incidence and a greater risk of EEG abnormalities than other antipsychotic agents (50)(51)(52). Although quetiapine has been less reported in the context of high seizure risk than olanzapine, some pharmacovigilance studies (52,53) and case reports (33,37,54,55) have also reported its association with seizure occurrence. Both these agents are closely related structurally to clozapine, which could explain the relatively higher seizure risk than other antipsychotic agents (53).…”

Delayed-Onset Seizure in a Mild Quetiapine Overdose: Report of a Case and Review of the Literature

“…Young et al [5] reported a case of a 27-year-old woman who ingested 30 g of quetiapine and who had two generalized tonic-clonic seizures after 24 hours, each lasting less than 1 minute and treated with lorazepam and propofol. Yam et al [6] described a 31-year-old man who ingested 4 g of quetiapine and was found unresponsive at home, presenting with a Glasgow Coma Scale score of 3.…”

Ketiapine Bağlı Gelişen Kardiyak Arrest ve Bilinç Kapanması

“…Oral alım sonrası hızla absorbe olarak, pik plazma konsantrasyonuna 1-2 saat içerisinde ulaşır. Karaciğerde metabolize olup primer idrar ile atılır (2). Antipsikotik kullanımı sırasında EKG değişikleri mortalite ve morbidite açısından önemli bir belirleyici olabilir.…”