Serotonin symptoms is a life-threatening condition. slowing, seizure, serotonin syndrome INTRODUCTION Serotonin syndrome is usually a life-threatening condition.[1] The core manifestations of this syndrome are neuromuscular excitation, autonomic nervous 1,2,3,4,5,6-Hexabromocyclohexane system hyperactivity, and switch in mental state.[2] Seizures in the setting of serotonin syndrome have been reported before. Seizures related to serotonin syndrome can be secondary to hyperthermia that exceeds 40C, electrolyte abnormalities, specific medication combinations (fluoxetineClithium, meclobemideCclomipramine), and specific medication overdosing including fluvoxamine, trazodone, tramadol, selective serotonin reuptake inhibitors, and 3,4-methylenedioxymethamphetamine.[3,4,5,6,7,8,9,10] Although overdose can lead to serotonin syndrome, it is most commonly caused by combining two or more serotonergic brokers, which can include drugs for many different purposes (antibiotics, antiemetics, supplements, etc.), not just psychiatric agents.[11] Acknowledgement of seizure as a symptom of serotonin syndrome is very important for early treatment and avoidance of long-term consequences. In this case, we report a patient who experienced a focal seizure with abnormal Electroencephalogram (EEG) in the setting of serotonin syndrome with no prior history of epilepsy or seizure provoking factors. CASE Statement Our patient is usually a 56-year-old Caucasian male with a known medical history of severe major depressive disorder and attention deficit hyperactivity disorder (ADHD). He was initially admitted to an outside hospital for acute onset of confusion, agitation, and sweating. The examination was amazing for fever of 38.1C, sinus tachycardia, tachypnea, upper chest and face flushing, altered mental status, hyperreflexia, rigidity, and resting fine tremors. Initial workup showed normal electrolytes, serum glucose, 1,2,3,4,5,6-Hexabromocyclohexane and thyroid function. Computed tomography of the head was unremarkable. Review of medications list revealed that patient was on duloxetine and aripiprazole with the new addition of amphetamine (for ADHD) and dextromethorphan (for upper respiratory contamination symptoms) a few days prior to symptom onset. While inpatient, the patient had an episode of behavioral arrest followed by rhythmic clonic movements from the still left higher extremity for 3C4min that was observed by your physician in the service. The individual was hard to arouse afterward for a couple of hours. Regimen electroencephalography (EEG) was performed and was exceptional for constant focal slowing over the proper temporal region. The individual was began on anti-seizure medicine (levetiracetam) and used in a tertiary infirmary for further administration. On the tertiary infirmary, further workup was executed including lumbar puncture method with unremarkable cerebrospinal liquid (CSF) analysis. The individual was positioned on constant EEG monitoring, which originally showed right aspect temporal blended delta and theta focal slowing furthermore to asymmetric reduced amplitude over the proper side [Body 1]. Contrasted human brain magnetic resonance imaging (MRI) research didn’t present 1,2,3,4,5,6-Hexabromocyclohexane any focal lesions or any various other intracranial process that may describe his symptoms. Open up in another window Body 1 An example web page of electroencephalogram during entrance shows right aspect temporal mixed delta and theta focal slowing in addition to asymmetric decreased amplitude over the right side on a longitudinal bipolar montage (double banana). Low frequency filter: 1 Hz, high frequency filter: 70 Hz, notch filter: off, sensitivity: 7 uV/mm The most likely diagnosis is usually serotonin syndrome per Hunter criteria and after ruling out other possibilities (central nervous system infection, autoimmune or inflammatory process, and thyroid storm).[10] Serotonergic medications including duloxetine, aripiprazole, amphetamine, and dextromethorphan were all held. The 1,2,3,4,5,6-Hexabromocyclohexane patient was started on standing benzodiazepine doses and cyproheptadine to alleviate the nervous system hyperexcitability. His symptoms gradually improved, and he returned to baseline within 4C5 days. During a subsequent encounter, a routine EEG study was carried out and was only significant for moderate generalized slowing, without any focal findings. DISCUSSION In this case, the patient was Rabbit Polyclonal to Trk A (phospho-Tyr680+Tyr681) found to have new onset focal clinical seizures with evidence of focal abnormality on EEG likely secondary to serotonin syndrome in the setting of normal MRI and CSF studies. None of the usual mechanisms of seizures in serotonin syndrome (severe hyperthermia, electrolytes abnormalities or medication overdosing) were involved in this case, which suggests that seizures in serotonin syndrome can be secondary to the generalized nervous system excitation. We hypothesize the patients encephalopathy was, in part, secondary to seizures as his mental status improved with seizure control as well as discontinuation of the offending medications and symptomatic management of serotonin syndrome 1,2,3,4,5,6-Hexabromocyclohexane manifestations. In one literature review, seizure frequency was as high as 29% of patients with serotonin symptoms.[4] In the published case reviews, the seizure semiology was generalized.[5,6,7,9] In prior case studies, there are some also.