Tonic–Clonic Seizure as the Presentation Symptom of Severe Hypocalcemia Secondary to Zoledronic Acid Administration

Navarro, M; López, R.A. Medina; Alañá, Mónica; Ocaña, Alberto; Leno, R.; Sánchez, Feliciano; Fonseca, E.; Cruz, Juan Jesús

doi:10.1089/jpm.2007.0113

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…In the literature, there are no other reported cases of seizure associated with BP in CRMO children. Indeed, treatment-related cases of seizures are mainly ZA infusion in connection with low level of calcium or glucose in elderly patients [8,9,10]. Overall, 5 cases of seizures occurring soon after BP administration were reported [11].…”

Section: Discussionmentioning

confidence: 99%

Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Miladi

Yasmine

Fazaa

et al. 2022

Sultan Qaboos Univ Med J

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Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterized by sterile bone lesions. We report a case of a patient with CRMO who developed a seizure post bisphosphonate administration. Although, the treatment of CRMO is currently not codified, the most promising results have been observed in patients under treatment with bisphosphonates. Keywords: CRMO; Bisphosphonate; tonico-clonic seizure.

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Section: Discussionmentioning

confidence: 99%

Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Miladi

Yasmine

Fazaa

et al. 2022

Sultan Qaboos Univ Med J

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“…Normal serum calcium levels are influenced by the effect of vitamin D 1,25-dihydroxy and PTH on calcium absorption, urinary calcium excretion, and bone remodeling activity in the skeleton (primary reservoir of calcium in the body) 10 . Therefore, antiresorptive therapy-mediated inhibition of bone resorption can lead to lower serum calcium levels and secondary hyperparathyroidism 10 , which could contribute to hypocalcemia, especially in individuals deficient in serum vitamin D or PTH 11 , 12 . Finally, renal insufficiency can lead to impaired conversion of vitamin D to its active metabolite (vitamin D 1,25-dihydroxy) and also may be a contributing factor to hypocalcemia 13 .…”

Section: Discussionmentioning

confidence: 99%

Severe hypocalcemia following a single injection of denosumab in a patient with renal impairment

Talreja

2012

Journal of Drug Assessment

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“…In all three cases, the level of 25-(OH)-D has been described as low (<30 ng/ml). Importantly, there was no description about magnesium level.There are also another two cases of seizures reported in association with the administration of the above drugs, and in both reports, hypocalcemia was thought to represent the underlying mechanism [Navarro et al 2007;Maclsaac et al 2002]. However, if we go through these two reports, then the respective authors have described that it is the underlying vitamin D deficiency leading to hypocalcemia causing seizure rather than alendronate or zoledronic acid.…”

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confidence: 97%

“…There are also another two cases of seizures reported in association with the administration of the above drugs, and in both reports, hypocalcemia was thought to represent the underlying mechanism [Navarro et al . 2007; Maclsaac et al .…”

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confidence: 99%

Seizure associated with zoledronic acid therapy: side-effects or coincidental finding?

Das

2011

Therapeutic Advances in Endocrinology

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Bisphosphonates have been used in a wide range of malignancies and bone disorders. Recently, there have been a few reports of seizure associated with alendronate and zoledronic acid. We discuss them, along with our experience with use of zoledronic acid.In a recent series, the authors described three cases of seizures that developed after the administration of zoledronic acid [Tsourdi et al. 2011]. However, among these three cases, hypoglycemia (caused by prior gastric surgery leading to dumping syndrome) was the predisposing factor behind two cases. In the third case, the patient developed a febrile seizure on the second day of zoledronic acid administration. The authors proposed that zoledronic acid induced an acute phase reaction that had lead to lowering of the seizure threshold and resulting seizure. However, the requirement for vasopressor support and response to iv antibiotics suggest intracranial infection rather than simple febrile seizure, which the authors have not ruled out by cerebrospinal fluid (CSF) analysis. In all three cases, the level of 25-(OH)-D has been described as low (<30 ng/ml). Importantly, there was no description about magnesium level.There are also another two cases of seizures reported in association with the administration of the above drugs, and in both reports, hypocalcemia was thought to represent the underlying mechanism [Navarro et al. 2007;Maclsaac et al. 2002]. However, if we go through these two reports, then the respective authors have described that it is the underlying vitamin D deficiency leading to hypocalcemia causing seizure rather than alendronate or zoledronic acid. The authors of both of the reports propose that the patients might have subclinical hypocalcemia before starting the drugs (as a result of vitamin D deficiency) which was aggravated by the administration of zoledronic acid.The risk factors for zoledronic-acid-induced hypocalcemia include pre-existing vitamin D deficiency, hypoparathyroidism, hypomagnesemia, and previous thyroid or parathyroid surgery [Tanvetyanon and Stiff, 2006]. These conditions impair the normal release and activity of parathyroid hormone which acts to compensate for low serum calcium by increasing renal absorption of vitamin D and calcium. Pre-existing vitamin D deficiency in a population receiving a bisphosphonate has also been reported in up to 27% [Wang-Gillam et al. 2008]. The elderly and cancer patients are at particular risk of vitamin D insufficiency due to limited Sun exposure, reduced dietary intake and renal impairment. In our experience in children with osteogenesis imperfecta, we found no clinical problems due to hypocalcemia in any of the patients [Panigrahi et al. 2010].Rapid parenteral administration of bisphosphonates, might lead to hypocalcemia; however, it is infrequent and usually mild. So before initiating bisphosphonate therapy, any disturbances of mineral metabolism (calcium, magnesium) should be corrected. Following the approval and widespread use of bisphosphonates, a number of potential side effects have be...

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Tonic–Clonic Seizure as the Presentation Symptom of Severe Hypocalcemia Secondary to Zoledronic Acid Administration

Cited by 10 publications

References 6 publications

Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Severe hypocalcemia following a single injection of denosumab in a patient with renal impairment

Seizure associated with zoledronic acid therapy: side-effects or coincidental finding?

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