Pregabalin Toxicity Manifesting as Reversible Encephalopathy With Continuous Triphasic Waves in Electroencephalogram

Abstract

A 74-year-old man with peripheral neuropathy due to diabetes presented with deliberate ingestion of 450 mg of pregabalin (PBG) over a period of 8 hours followed by altered mental status. A bedside electroencephalogram was performed to rule out nonconvulsive status epilepticus, which showed continuous triphasic waves (TWs) with slow background activity. He recovered after 48 hours of stopping PBG, and his repeat electroencephalogram after 72 hours did not show any TWs. We present a rare case of PBG-induced TWs thereby highlighting the extent of the etiologic spectrum of TWs and discussing the literature related to this association.

Pregabalin induces pathological changes in cerebrum and cerebellum of Albino Rats

“…These changes were attributed to the direct effect of PGB on the brain. These results were similar to previous reports of PGB causing encephalopathy and EEG changes [18][19][20].…”

The Effectiveness of Hemodialysis in case of Intoxication with Pregabalin

“…Further, hepatotoxicity induced by pregabalin use was also suggested in the literature (11). In a study conducted in 2017 by Parekh et al (12), pregabalin overuse was reported to cause transient encephalopathy, together with continuous triphasic waves in electroencephalogram.…”

Prolonged encephalopathy and associated nonconvulsive seizures from suspected pregabalin and tapentadol: Two case reports and review of literature

“…9 PGB-induced seizures respond well to stopping the drug and supportive measures. 17 However, prolonged encephalopathy up to 48 hours post-PGB-induced seizures has been reported. 8 Tapentadol is a synthetic mu-receptor agonist with 2-3 times lower affinity compared to morphine, but with additional noradrenaline (norepinephrine) reuptake inhibition within the CNS.…”

“…PGB‐induced delirium, in older patients with multiple medical comorbidity and concurrent medications, is well reported; however, it may occur in young patients too 9 . PGB‐induced seizures respond well to stopping the drug and supportive measures 17 . However, prolonged encephalopathy up to 48 hours post‐PGB‐induced seizures has been reported 8…”