Non convulsive refractory status epilepticus induced by thiocolchicoside (TCC) intrathecal injection: A case report

Abstract

TCC is a semisynthetic molecule widely used in clinical settings as a pain killer and myorelaxant. Several neurological side effects have been reported in association with TCC treatment including somnolence, confusion and seizure, the latter in a lower percentage of patients. Some previous reports described seizure onset after TCC intake in adulthood. However, major epileptological complication, namely status epilepticus, has never been previously reported in association with TCC treatment. In our report, we describe a case of acute refractory non‐convulsive status epilepticus (NCSE) in the context of a TCC‐induced acute toxic encephalopathy (ATE) in a woman without any previous neurological or physical comorbidities.

Epileptogenic activity of thiocolchicoside

“…Considering that, in Italy, thiocolchicoside in parenteral preparations is currently available at 4 mg in 2 mL water for injectable solutions per ampoule, this is the likely dose that was administered in the patient studied by Evangelista et al 1 In effect, this is a low dose of thiocolchicoside that fits previous studies of our group documenting the powerful epileptogenic activity of this compound at very low doses in animals and humans. 2,3 In particular, in rats, thiocolchicoside given by microinjection to the cerebral cortex (2 μg/μL) was able to induce within few minutes electrographic and behavioural activity of focal motor seizures, rapidly developing into a focal status epilepticus.…”

“…1 The authors discuss a case of nonconvulsive refractory status epilepticus related to the erroneous intrathecal injection of thiocolchicoside for treatment of muscle contractions and low back pain. 1 While the authors for the most part have done an accurate discussion, surprisingly in the article the doses of intrathecal thiocolchicoside administered have not been specified; moreover, a few other points such as the ability of thiocolchicoside to cross the blood-brain barrier (BBB) and the main neurochemical mechanisms underlying the epileptogenic activity of this compound may need further elucidation. To further address these points is important for understanding the determinants involved in the occurrence of neurological side effects related to thiocolchicoside and thus the prognosis of the patient.…”