Seizures induced by NSAID

Abstract

Adverse reactions to nonsteroidal antiin¯ammatory drugs (NSAID) have been recognized for years. Such reactions include acute asthmatic attacks or perpetuation of ongoing asthma, initiation or perpetuation of chronic urticaria, and anaphylactic or anaphylactoid episodes (1). In this paper, we report the case of an infrequent NSAID adverse effect con®rmed by oral challenge test. This case illustrates indomethacin-and acetylsalicylic acid (ASA)-induced seizures. A 65-year-old man without a remarkable neurologic and atopic medical history had an episode of seizures about 15 min after ingestion of one Inacid 2 tablet (indomethacin 50 mg). He had taken no other medication. The man complained of abdominal pain and rapid onset of profuse sweating, loss of consciousness, tonic extension of the arms, and turned up eyes, without urinary incontinence. The symptoms resolved within 3±4 min without treatment, with slow return to complete lucidity: after seizure, the patient was confused, sleepy, and uncooperative for several minutes before full recovery. Results of physical examination were unremarkable, neurologic examination showed no abnormalities other than limited drowsiness. General analysis and kidney function were normal, as was computed tomography (CT) of brain, electroencephalogram (EEG), and Holter electrocardiogram. During the allergologic evaluation, the patient was orally challenged, after giving written, informed consent. A single, nonchewable, 50-mg indomethacin tablet (regularstrength Inacid) was used. The patient repeated the previous clinical features 10 min after the ingestion of the tablet. He had no other symptoms. We also performed oral challenge with ASA, and diclofenac, with good tolerance. The patient was followed up for 2 years, and during this time he received ASA on several occasions without dif®culty. After this period of time, he presented a new episode of seizures, similar to those previously described, 10 min after ingestion of 500 mg ASA. General and neurologic examination, general analysis, kidney function, brain CT, and EEG were again normal. After discussion with him about adverse reactions to NSAID, a new challenge was undertaken only with salicylate and isonixin, with tolerance. The patient did not have any symptoms during or after the challenge. We did not perform oral challenge with AAS and other NSAID because informed consent was not given by the patient. Many drugs are known to cause convulsions in many different circumstances. In order to focus on this problem properly, one must clearly distinguish between situations in which this adverse effect is observed at therapeutic dosages and conditions in which seizures are part of the clinical picture of poisoning (2). In this particular case, the seizures developed after standard dosage of the drugs, and they were not followed by other symptoms. These features indicate NSAID to be the trigger factor. Seizures have occasionally been reported during NSAID therapy: mefenamic acid (3), ibuprofen (4), and diclofenac (5) have been implicated. In ...

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