Abstract
Introduction
Tiagabine (TGB) is a novel antiepileptic that decreases GABA uptake. The literature contains one report of an adult with epilepsy who ingested up to 1 gram of TGB and developed status epilepticus. We reported on a pediatric patient who ingested significantly less TGB but still developed tonic-clonic seizures.
Case report
A previously healthy, 13 kg, two-year-old girl developed generalized tonic-clonic seizure activity at home approximately 1 hour after ingesting 90 mg of her grandmother’s TGB (forty five 2 mg tablets). At the hospital she had two 5 minute seizures at 1.5 and 3.5 hours post ingestion. Her serum TGB levels were 530 and 130 ng/ml approximately 5 and 11 hours post-ingestion (5–70 ng/ml trough levels with most probable range for seizure control). She was discharged 27 hours post ingestion, and she was in good condition.
Conclusion
An overdose of TGB, a novel anti-epileptic, can cause convulsive seizures.
Keywords: tiagabine, seizures, overdose, pediatrie
Full Text
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Footnotes
There was no outside funding of any kind used for this study.
References
- 1.FDA Approved Labeling Text dated February 14, 2005 www.fda.gov/cder/foi/label/2005/02064s0141bl.pdf (Accessed May 14th,2005).
- 2.FDA medwatch. www.fda.gov/cder/drug/infopage/ tiagabine/tiagabine/default.htm (Accessed May 14th,2005).
- 3.Nielsen EB, Suzdak PD, Andersen KE, Knutsen LJ, Sonnewald U, Braestrup C. Characterization of tiagabine (NO-328), a new potent and selective GABA uptake inhibitor. Eur J Pharmacol. 1991;196(3):257–266. doi: 10.1016/0014-2999(91)90438-V. [DOI] [PubMed] [Google Scholar]
- 4.Leach JP, Brodie MJ. Tiagabine. Lancet. 1998;351(9097):203–207. doi: 10.1016/S0140-6736(97)05035-6. [DOI] [PubMed] [Google Scholar]
- 5.Sarup A, Larsson OM, Schousboe A. GABA transporters and GABA-transaminase as drug targets. Current drug targets-CNS and neurological disorders. 2003;2(4):269–277. doi: 10.2174/1568007033482788. [DOI] [PubMed] [Google Scholar]
- 6.Ostrovskiy D, Spanaki MV, Morris GL. Tiagabine overdose can induce convulsive status epilepticus. Epilepsia. 2002;43(7):773–774. doi: 10.1046/j.1528-1157.2002.51601.x. [DOI] [PubMed] [Google Scholar]
- 7.Leach JP, Stolarek I, Brodie MJ. Deliberate overdose with the novel anticonvulsant tiagabine. Seizure. 1995;4(2):155–157. doi: 10.1016/S1059-1311(95)80098-0. [DOI] [PubMed] [Google Scholar]
- 8.Fitzek S, Hegemann S, Sauner D, Bonsch D, Fitzek C. Drug-induced nonconvulsive status epilepticus with low dose of tiagabine. Epileptic Disorders. 2001;3(3):147–50. [PubMed] [Google Scholar]
- 9.Shinnar S, Berg AT, Treiman DM, Hauser WA, Hesdorffer DC, Sackellares JC, Leppik I, Sillanpaa M, Sommerville KW. Status epilepticus and tiagabine therapy: review of safety data and epidemiologic comparisons. Epilepsia. 2001;42(3):372–9. doi: 10.1046/j.1528-1157.2001.01600.x. [DOI] [PubMed] [Google Scholar]
- 10.Cantrell FL, Ritter M, Hirnes E. Intentional overdose with tiagabine: an unusual clinical presentation. J Emerg Med. 2004;27(3):271–2. doi: 10.1016/j.jemermed.2004.06.003. [DOI] [PubMed] [Google Scholar]
- 11.Lau AH, Gustavson LE, Sperelakis R, Lam NP, El-Shourbagy T, Qian JX, Layden T. Pharmacokinetics and safety of tiagabine in subjects with various degrees of hepatic function. Epilepsia. 1997;38(4):445–51. doi: 10.1111/j.1528-1157.1997.tb01734.x. [DOI] [PubMed] [Google Scholar]
- 12.Mengel H. Tiagabine. Epilepsia. 1994;5(5):S81–S84. doi: 10.1111/j.1528-1157.1994.tb05976.x. [DOI] [PubMed] [Google Scholar]
- 13.Kellinghaus C, Dziewas R, Ludemann P. Tiagabine-related non-convulsive status epilepticus in partial epilepsy: three case reports and a review of the literature. Seizure. 2002;11:243–249. doi: 10.1053/seiz.2001.0594. [DOI] [PubMed] [Google Scholar]
- 14.de Borchgrave V, Lienard F, Willemart T, van Rijckevorsel K. Clinical and EEG findings in six patients with altered mental status receiving tiagabine therapy. Epilepsy Behav. 2003;4(3):326–37. doi: 10.1016/S1525-5050(03)00107-0. [DOI] [PubMed] [Google Scholar]
- 15.Balslev T, Uldall P, Buchholt J. Provocation of non-convulsive status epilepticus by tiagabine in three adolescent patients. European Journal of Paediatric Neurology. 2000;4(4):169–70. doi: 10.1053/ejpn.2000.0293. [DOI] [PubMed] [Google Scholar]
- 16.Leppik IE, Gram L, Deaton R, Sommerville KW. Safety of tiagabine: summary of 53 trials. Epilepsy Res. 1999;33(2):235–46. doi: 10.1016/S0920-1211(98)00094-1. [DOI] [PubMed] [Google Scholar]
- 17.Richards DA, Lemos T, Whitton PS, Bowery NG. Extracellular GABA in the ventrolateral thalamus of rats exhibiting spontaneous absence epilepsy. A microdialysis study. Journal of Neurochemistry. 1995;65:1674–80. doi: 10.1046/j.1471-4159.1995.65041674.x. [DOI] [PubMed] [Google Scholar]