Tonic Convulsions Research Articles

A probable case of sodium valproate monotherapy induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report in Indian population

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity syndrome most commonly caused by anti-epileptics like carbamazepine, phenytoin. It usually manifests as maculopapular rash, fever, eosinophilia, generalized lymphadenopathy, hepatitis, atypical lymphocytosis, and leucocytosis with the involvement of other organs. Valproate, a broad-spectrum antiepileptic, also used in bipolar disorders and migraine prophylaxis, is generally well tolerated. To date, very few cases of valproate monotherapy induced DRESS syndrome have been reported worldwide and here we are reporting one such rare case in a 72 years old Indian woman with a history of generalised tonic convulsions. The patient was classified as a ‘probable’ case of DRESS syndrome using the WHO-UMC criteria and Naranjo scale. Discontinuation of the offending medication and treatment with intravenous (IV) fluids, antihistamines, and steroids helped in recovery of the patient. Healthcare practitioners must be aware of valproate monotherapy induced DRESS syndrome and take effective measures to avoid severe side effects.

Pseudo Bulbar Palsy a Rare NEURO-COVID Presentation

Background: The Global pandemic of COVID-19 with more than half million people passed away from their families tragically, wide variety of signs and symptoms resulted from this Novel SARS Cov2 virus. Although the respiratory and Gastro-intestinal symptoms are dominant, however, neurological symptoms whether specific or nonspecific have been reported. Till now the extents of knowledge regarding the neurological sequel of COVID-19 infection are finite. Pseudo Bulbar Palsy is a neurological disease characterised by dysarthria, dysphagia, facial and tongue weakness in addition to emotional liability resulted from an upper motor neuron lesion in the corticoid bulbar tracts. Peripheral neuropathy, Demyelisation and vascularise are underlying aetiologies. This will result in deglutition, and speech disturbance. Case presentation: 60 years old male from Najaf, went to the emergency department with three days history of drowsiness and anorexia after COVID-19 related fever and myalgias. He had significant risk factors. He had 2 weeks fever following a contact with COVID-19 patient. Examination revealed drowsiness, dehydration, the patient was not aware for time and place, eye refluxes was symmetrical. The face was normal with exaggerated jaw jerk CT of the chest showed evidence of COVID-19 infection confirmed by positive PCR. Brain CT showed only brain atrophy without signs of localised ischemia. Farther blood investigations confirm activity of infection. During this the patient developed tonic clonic convulsion required anticonvulsant therapy; he remained semiconscious, with difficulty to swallow and dysarthria, Irritability, drowsiness and disorientation. He received anticoagulant, Steroids, mannitol. The condition improved and the patient discharged in better condition with two weeks anticoagulation. Discussion: this is a story for a rare complication belong to COVID-19 infection, treated as a stroke, as mention in literatures, many recorded cases of Neurocovid that required treatment accordingly. Conclusion: neurological symptoms of COVID-19are extreme and might be nonspecific but some time life threatening, these might overlap severe infection. The improvement in the neurological sequel overlap the COVID-19 improvement both clinical aspect and investigation.

Dravet Syndrome -A case report from Aseer, Saudi Arabia

Dravet syndrome (DS) is an epileptic encephalopathy that presents with protracted seizures in infancy, associated with fever, and frequently categorized as febrile seizure at first presentation. In the second year, myoclonia, atypical absence and complex partial seizures develop. The correct diagnosis of DS and appropriate follow-up are delayed until after appearance of signs of developmental regression in the second year of life. Timely detection and diagnosis of DS followed by management with suitable anticonvulsants and treatment plan may reduce the seizure burden and improve long-term developmental outcome. We present a case of 2 years old female with recurrent attacks of generalized tonic colonic convulsion after 1st febrile convulsion diagnosed as Dravet syndrome. The diagnosis was based on history and gene study (SCN1A).
 Bangladesh Journal of Medical Science Vol.19(2) 2020 p.315-318

Hydrocarbon’s Chronic Kidney Disease

Hydrocarbons are dangerous for health, and American Society of Nephrology has already described renal involvement by Hydrocarbon. The Republic of Congo produces oil but there is no study among these working with hydrocarbon to evaluate their renal status. The patient of 39 years working for 5 years as carrier oil, with high exposure to oil or more than 2 hours per day. He has no history of herbal medicine, no edema, no diabetes, no high blood pressure and he was not suffering from infectious diseases and there was no concept of kidney disease in the family. He was hospitalized for febrile generalized tonic convulsions with impaired renal function. After patient stabilization, clinical and biological examinations allowed us to conclude the chronic glomerulonephritis syndrome in five stages of chronic kidney disease. As creatinine at the entrance was 195 mg/l, clearance was 3 ml/min 1.72 m2 by CKD-EPI. The entrance to the BUN was 3.57 g/l. The albumin to creatinine ratio of urinary of 300 mg/g (ACR) is a glomerular disease. HIV serology test was negative. The abdominal-pelvic ultrasound revealed dedifferentiated kidneys of normal size. The patient received 7 hemodialysis sessions with femoral right catheter with heparin. The evolution was good and the patient was enrolled in chronic hemodialysis. This interference could be regarded as an occupational disease and we wish early detection.

Unexpected complication of a common therapy in a pregnant patient

Background: Pre-eclampsia/eclampsia is a life-threatening disease with considerable risks on maternal and neonatal health. Globally, it affects between 2–8% of all pregnancies. Worldwide, approximately 63,000 pregnant women die each year due to pre-eclampsia/eclampsia. The MAGPIE (Magnesium sulphate for Prevention of Eclampsia) trial stated that the risk of developing convulsions was lowered significantly (58%) in severe pre-eclampsia patients who received magnesium sulfate in comparison to the placebo group.1 The exact mechanism of action of magnesium sulfate (MgSO4) is not completely understood, blocking calcium channels and decreasing availability of calcium for smooth muscle contractions has been suggested. Pritchard advocated that therapeutic concentration of MgSO4 should be between 2-4 mmol/l.2 Despite strong evidence of the effectiveness of MgSO4, concerns have been expressed about the risk of hypocalcemia to the patient when used alone or concomitantly with nifedipine as both of them affect calcium metabolism.3 Hypermagnesemia causes hypocalcemia by inhibiting parathyroid hormone secretion and increases urinary excretion of calcium. Severe hypocalcemia is a life-threatening condition and may lead to focal or generalized tonic muscle cramps, convulsions, arrhythmia, and laryngospasm and stridor which is common in the pediatric population but has also been reported in adults.4 A case of symptomatic hypocalcemia secondary to hypermagnesemia is extremely rare, and to the best of our knowledge, only a few cases have been reported.5 We believe this is the only case in the literature with stridor and potential airway obstruction. Case: A 30-year old black South African woman, gravida 5, para 3+1, presented with severe preeclampsia (BP 215/145 mmHg, proteinuria +2), and preterm premature rupture of membrane at 33 weeks of gestation. General and obstetric examinations were unremarkable. Laboratory parameters on admission showed acute kidney injury, anemia and elevated lactate dehydrogenase and alkaline phosphatase. Other investigations were normal (Table 1). She was admitted to the high dependent unit and received 10 grams of intramuscular MgSO4, followed by continuous intravenous infusion at a rate of 2 g/hour for 24 hours. Her blood pressure dropped to 145/95 mmHg. Three hours post-admission, her blood pressure raised to 186/124 mmHg and was controlled with a labetalol intravenous infusion and nifedipine 10 mg orally. Her blood pressure then dropped to 150/90 mmHg. Six hours post-admission, the patient had an uneventful emergency caesarean section under spinal anesthesia for fetal distress. Nine hours post-admission, the patient had dyspnea, respiratory distress, and inspiratory stridor, and chest examination was unremarkable. While checking her blood pressure, the patient had carpopedal spasm (Trousseau's sign) and masseter muscle spasm (Chvostek's sign). MgSO4 infusion was stopped. She received 10 ml of 10% calcium chloride over 10 minutes and responded dramatically to resuscitation and calcium chloride. Investigations (arterial blood gas, FBC, urea and electrolytes) were performed and showed low ionized calcium 0.89 mmol/l and her magnesium level was 2.74 mmol/l. Conclusion: Although MgSO4 is considered as the treatment of choice for the prevention of convulsions in pre-eclampsia/eclampsia patients, concerns have been raised regarding the risk of severe hypocalcemia, especially when used concomitantly with calcium channel blockers. Prospective studies designed in a controlled fashion are needed to assess the safe combination of magnesium sulfate and nifedipine.

DIFFICULTIES OF EARLY INFANTILE EPILEPTIC ENCEPHALOPATHY-9 DIAGNOSTIC

Introduction: Early infantile epileptic encephalopathy (EIEE) is a group of monogenic epilepsies which are caused by mutations in more than 70 genes. Material and methods: The data of a long-term dynamic EEG observation of a girl with EIEE9 (OMIM 300088) caused by a mutation in the PCDH19 gene (OMIM 300460) are presented. Results: Correct etiological diagnosis of the hereditary disease was established only at the age of 14 years. Epilepsy debuted at the age of 8 months as a series of one minute long generalized tonic convulsions with myoclonia in the left arm. After further examination the symptoms were mistakenly regarded as viral encephalitis. Subsequently, clusters of convulsive seizures provoked by febrile states periodically were occurring several times per year irrespective of the type and amount of anticonvulsants taken. Despite the fact, that no significant structural changes in the brain we found during neuroimaging, pharmacoresistant focal epilepsy gradually developed. At the age of 14 years, as part of a pre-surgical examination for two days, the complete abolition of anticonvulsants and the implantation of subdural electrodes were performed. Focal motor seizures with a transition to bilateral tonic-clonic seizures were recorded, during which the primary generation of epileptic activity was localized in the left temporal lobe. А thorough examination with a clarification of the monogenic origin of the disease made it possible to avoid undue surgery on the brain. Discussion: The presented observation is a clear example of why a timely genetic examination is important for establishing correct diagnosis, adequate selection of anticonvulsants and a making a right decision on the possibility of surgical treatment.

Effect of Ethosuximide on Audiogenic Epilepsy in Krushinsky-Molodkina Rats.

The anticonvulsant effect of ethosuximide (T-type calcium channel blocker) was evaluated in Krushinsky-Molodkina rats predisposed to audiogenic epilepsy. Ethosuximide given with drinking water (300 mg/kg/day) over 45 days slightly reduced proneness to audiogenic epilepsy and increased locomotor activity of the animals at the periphery of the open field. Neonatal administration of ethosuximide (3-4 mg per animal, from 2 to 10 days of life) insignificantly modulated the parameters of audiogenic epilepsy in these animals at the age of 1.5 months and reduced manifestation of audiogenic myoclonic convulsion that developed after long daily sound presentation started at the age of 3 months. The findings attested to a weak anticonvulsant effect of ethosuximide on tonic convulsions with its predominant effect on convulsions with forebrain focus location.

Efficacy of a Novel Mechanical Cervical Dislocation Device in Comparison to Manual Cervical Dislocation in Layer Chickens.

Simple SummaryOn-farm euthanasia of diseased or injured chickens is a common task within the poultry industry. For animal welfare, the aim of any euthanasia technique is to achieve rapid loss of sensibility, for the process to cause minimal pain, and for death to follow quickly. Manual cervical dislocation (separating the skull from the spine by hand) is a common method for killing poultry on farms, but it can be aesthetically displeasing. Therefore, different tools for neck dislocation (separating the skull from the spine by mechanical device) are developed as alternative euthanasia methods. These tools need scientific assessment for their effectiveness and humaneness. The Koechner Euthanasia Device (KED) (Koechner MFG. CO., INC, USA) is commercially available as a mechanical cervical dislocation tool for poultry. We compared the efficacy of KED with manual cervical dislocation based on time to brain death (irreversible insensibility) and degree of damage to the brain and neck in anesthetized chickens. The anesthetic agents reduced any distress and pain associated with the killing technique. Our results indicated that KED resulted in less damage to the brain, causing longer times to brain death and cardiac arrest in comparison to manual cervical dislocation. We suggest that manual cervical dislocation is more efficient and humane for layer chicken euthanasia than KED.The main objective of this study was to assess the efficacy of mechanical cervical dislocation using the Koechner Euthanasia Device Model C (KED) in comparison to manual cervical dislocation in layer chickens. Laying hens and/or roosters in three different age groups (12, 27–29, and 65–70 weeks old) were randomly assigned to one of three experimental groups: manual cervical dislocation in conscious birds (CD), manual cervical dislocation in anesthetized birds (aCD), or mechanical cervical dislocation by KED in anesthetized birds (aMCD). Anesthetized birds received an intramuscular dose of 0.3 mg/kg medetomidine and 30 mg/kg of ketamine to achieve clinical anesthesia. A comparison of CD vs. aCD responses confirmed that the anesthetic plane abolished or reduced clonic convulsions, nictitating membrane reflex, tonic convulsions, and cloacal relaxation. Time to loss of the pupillary light reflex (~123 s), and time to cardiac arrest (~172 s) were longer (p < 0.001) in the birds in the aMCD group than aCD (~71 and ~137 s, respectively). Radiographs revealed that the majority of the birds killed by manual cervical dislocation (CD + aCD) had dislocations between the skull and atlas (C1) or between cervical vertebrae C1–C2. The KED resulted in a majority of dislocations at C2–C3. Birds killed by manual cervical dislocation presented more subdural and parenchymal hemorrhage in the brain stem compared to birds killed by KED. Radiographs indicated the presence of fractures in a few birds killed by either method (CD + aCD versus aMCD). Compared to manual CD, KED resulted in less brain trauma and a longer latency to brain death, indicating a lower efficacy of KED as an on-farm killing method.

Evaluation of the hepatoprotective, anti-inflammatory, antinociceptive and antiepileptic activities of Chrysanthemum trifurcatum

Chrysanthemum trifurcatum is common to Mediterranean countries and widely-used in traditional medicine. Due to the scarcity of data about the pharmacological properties of C. trifurcatum, this present study was designed to determine the effects of C. trifurcatumethanolic extract (CEE) for its anti-nociceptive, anti-epileptic, anti-inflammatory, and hepatoprotective activities in mice and rat models. We demonstrate that CEE contains alkaloids, carbohydrates, and flavonoids, and in a dose-dependent (300 and 500 mg/kg) manner exhibited significant reductions in paracetamol (PCM; 500 mg/kg)-induced increased serum AST, ALT and ALP levels, similar to as seen by silymarin (25 mg/kg). Additionally, CEE (300 mg/kg) elicited inhibition in acetic acid-induced abdominal writhes, delayed latency time to paw’s licking in hot plate tests, exerted an anti-convulsant effect by prolonging the onset of clonic and tonic convulsions, and reduced pentylenetetrazole (PTZ; 80 mg/kg)-induced mortality. Moreover, CEE (500 mg/kg) exhibited a prominent reduction in carrageenan-induced paw edema. These studies indicate that CEE possesses profound central and peripheral analgesic, anti-convulsant, anti-inflammatory, and hepatoprotective activities.

Anatomical Pathology, Behavioral, and Physiological Responses Induced by Application of Non-penetrating Captive Bolt Devices in Layer Chickens.

We evaluated three models of non-penetrating captive bolt devices, Zephyr-E, Zephyr- EXL, and Turkey euthanasia device (TED) for time to loss of sensibility and degree of brain damage during euthanasia in four age groups of male and female layer chickens (10–11, 20–21, 30–35, 60–70 weeks respectively). Latencies to onset of insensibility and cardiac arrest were assessed to detect whether killing birds via these devices was humane and effective. Both gross and microscopic pathology evaluations were conducted to score skull and brain trauma post mortem. All three NPCB devices induced loss of breathing, pupillary reflex and nictitating membrane reflex within 5 s after application in most chickens. Latencies to loss of jaw tone and neck muscle tone were longer in 60–70 weeks old roosters (p < 0.05). Younger birds (10–21 week-old) demonstrated the longest time (p < 0.0001) to onset of tonic convulsions, time at last movement, cloacal relaxation and cessation of heart beat. A positive correlation (p < 0.0001) was found for all three devices between time of cardiac arrest and times to onset of tonic convulsions, last movement, and cloacal relaxation. More than 80% of birds had skin lacerations with external bleeding following application of all 3 devices. Device type did not affect the incidence of skull fractures but higher skull fracture scores were noted in 10–11 week-old birds compared to other ages. Regardless of device type and age, microscopic SDH was most apparent in the brain and proximal spinal cord of all birds. In summary, all three devices caused significant trauma to the midbrain and spinal cord. Results demonstrated that all three devices induce rapid insensibility after application and can be used as a single-step method that results in a humane death in all age groups of layer chickens.

Anticonvulsant and GABAnergic Activity of Nigella sativa oil in Mice

Several experimental studies have described neuroprotective and antioxidant activity of plant extracts and its oil as Nigella sativa. The existing study was conducted to investigate the anticonvulsant activity of Nigella sativa oil. Fifty five male albino mice were used through three experiments; each experiment was taken 1 week. The experiments were pentylenetetrazole induced convulsion, maximal electric shock induced convulsion and neurotoxicity tests. Mice were treated with Nigella sativa oil 10 ml/kg; using sodium valproate (100 mg/kg) and phenytoin sodium (25 mg/kg) orally as standard drugs. In pentylenetetrazole induced convulsion, onset of seizure and generalized seizures were measured, beside the gamma aminobutyric acid and antioxidant enzymes levels assessments. In maximal electric shock, mice were observed for hind limb tonic convulsion. Nigella sativa oil significantly delayed seizure onset after pentylenetetrazole induced convulsion but had no effect on electric shock induced convulsion. Nigella sativa showed a good antioxidant activity and increased gamma amino butyric acid level in brain and had neuroprotective effects.

A Review on anti-epileptic activity of seaweed Ecklonia cava

The Present study was undertaken to investigate the Anticonvulsant activity of sea weed extract of Ecklonia cava on electrically and chemically induced seizures in wistar rat. The methanolic seaweed extract was studied for its anticonvulsant activity by using experimental paradigms like Maximal electroshock-induced seizures (MES). Expected to exhibited protection against tonic convulsions induced by MES in wistar rats. Objective of these studies were designed to screen the antiepileptic activity of the seaweed Ecklonia cava in experimental laboratory animals.&#x0D; Keywords: Antiepileptic Activity, Ecklonia cava (E.C), seizures, Flexon, Hind Limb Extension, Electroencephalography (EEG)

Inhibition of 4-aminopyridine-induced seizures in mice by a novel 3-substituted 1,4-benzodiazepine

Some of highly effective antiepileptic substances share the polymodal pharmacological action which determines the possibility of their use for treatment of pathogenetically similar diseases. Inhibitory mediator systems influence for example, suggests the combination in the pharmacological spectrum such actions as antiepileptic, analgesic (antineuropathic) and other actions.&#x0D; The aim of the study was evaluation of anticonvulsant effect of 7-bromo-5-(o-chlorophenyl)-3-propoxy-1,2-dihydro-3H-1,4-benzodiazepin-2-one (propoxazepam) on the model of 4-aminopyridine (4-AP) – induced myoclonic seizures and characterization of its possible participation in modulation of the function of voltage-dependent potassium channels.&#x0D; 4-AP (10.3 mg/kg, subcutaneously) was administered 30 minutes after intraperitoneal administration of propoxazepam different doses (20, 28, 40, 60 and 80 mg/kg) and the time and quantity of myoclonic and tonic convulsions as well as total time to the lethal effect were evaluated.&#x0D; It was found that in this model, propoxazepam possess moderate activity (ED50 = 37,3 ± 7.9 mg/kg) Even at high doses (80 mg/kg) of the test compound, anticonvulsive action did not reach 100%. The quantity of myoclonic seizures and the latency time of their onset have no statistically significant differences in comparison with the data of animals of the control group. On the contrary, the number (and percentage representation) of tonic convulsions in the common seizure episode increased, which is due to the possible inhibitory effect of propoxazepam, which is carried out primarily through GABA-ergic mechanisms.

Deep tongue laceration following eclampsia, Cesarean section, repair and blood transfusion- A case report

Eclampsia still remains an issue of serious concern in Sub Saharan Africa. Preeclampsia is the precursor to eclampsia, in which hypertension and proteinuria are present, with or without oedema1-2. This is a case of Mrs SK, a 21year old Primigravida who was unsure of her last menstrual period, but she was said to be 9 months pregnant; she developed generalized tonic clonic convulsions with each episode lasting about 30 seconds. She sustained a V-shaped laceration affecting lower one third of the tongue with clots of blood on the affected area. A diagnosis of antepartum eclampsia was made. She was admitted into the eclamptic ward and resuscitated. Intravenous infusion and Magnesium sulphate were commenced using Zuspan Regimen. She had an emergency caesarean section and was delivered of a fresh still birth female baby who weighed 3.0kg. The lacerated tongue was repaired by maxillofacial surgeon and she was transfused with 2 pints of blood.Eclampsia is the leading cause of maternal mortality in developing countries. Recognizing the features of preeclampsia and instituting appropriate measures is mandatory in order to prevent the progression of the disease to eclampsia with its associated complications.

Влияние вдыхания паров толуола на интенсивность аудиогенного судорожного припадка у крыс линии Крушинского–Молодкиной

Аctuality. The significant proportion of human epilepsy is resistant to anticonvulsant drug therapy, which makes actual the problem of search for new alternative antiepileptic therapies. The goal of this work was the analysis of the effects created by the inhalation of toluene vapor (the strong odorant) on epileptic seizures in rats of Krushinsky-Molodkina strain, which is highly prone to audiogenic epilepsy (AE), the tonic convulsions of the musculature as well as audiogenic myoclonic seizures which develop as the result of serial daily sound exposure. Methods. Rats (n=14) were exposed to 15-s inhalation of toluene vapor with the subsequent (in 20 s) testing of their audiogenic seizure intensity. Results. The toluene action induced a significant reduction in tonic and myoclonic seizure intensity in comparison to the background data of AE sensitivity obtained 1 week prior to the toluene test. In 13 of 14 animals, the seizures ended as the clonic seizures (no tonic seizures developed), while all animals developed tonic seizures in the “background” experiment. All rats developed myoclonic seizures (audiogenic kindling) prior to toluene action while no myoclonic seizures were noted after toluene inhalation in all animals. Conclusion. The results obtained complement the previously published data using WAR strain of rats on the relationship between epilepsy and olfactory system. The anticonvulsive effects of toluene vapor inhalation on the expression of AE signs demonstrate both the importance of genetic models usage in such investigations and the importance of olfactory stimulation as the potential anti-convulsant agent.

Disease Profile of Seizure in Children

This study was done in the Departmen tof Paediatrics, Rajshahi Medical College Hospital, Rajshahi to final out the disease profile of children Hospitalised with seizure presentation. From 01/01/14 to 31/12/14 period a total of 12,560 children in the age group 6 months to 12 years were admitted in the Paediatric department. Among these 656 (5.2%) children were admitted due to convulsion. 62.8% were male and 37.2% female, 53% febrile and 47% a febrile, 59% were less than 5 years. Generalized tonic clonic convulsion (GTC) was the most common seizure type (72.8%). Febrile convulsion, seizure disorder, meningitis and encephalitis were common causes of convulsion.TAJ 2012; 25: 35-37

Rasmussen's Encephalitis. A Case Report

Rasmussen's encephalitis (RE) is a rare but severe immune-mediated brain disorder leading to unilateral hemispheric atrophy, associated progressive neurological dysfunction with intellectual decline, and intractable seizures. It is a well-established cause of pharmacologically intractable epilepsy. The report is on a 17-month-old infant, treated at the Mario Catarino Rivas Hospital Honduras. Family history: grandfather epileptic secondary trauma from 20 years. Personal history: two previous emergency visits (at 16 months and 16 months 8 days) for convulsions for which she was admitted three days and was treated with valproic acid 30 mg/kg per day. The infant is admitted in the emergency, with a history of about three hours after onset of tonic convulsions, focused on left-side with drooling, oculogiros and relaxation of sphincters and fever of 38.5 ° C. Entered as convulsive syndrome in the study, however, as the days passed the number of seizures increased to 60 per day and was gradually presenting alterations in neurodevelopment. MRI reported leukoencephalopathy of undetermined origin and biopsy reported findings consistent with Rasmussen's syndrome. She was treated with immunoglobulin every two weeks for six doses after two months of hospitalization with achieved improvement. Currently, episodes of seizures have decreased significantly and almost not convulsing, she presented alterations in neurodevelopment.

TOXICOLOGIC EVALUATION OF 2-METHOXYBENZOIC ACID AS A RISK FACTOR FOR WORKERS’ HEALTH.

The authors studied toxic properties of 2-methoxybenzoic acid for its hygienic regulation in the air of workplace. Values of average lethal dose (DL50) for male rats, male mice and female mice equal 5945, 3183 and 3030 mg/kg respectively. 2-methoxybenzoic acid is a highly dangerous substance (2nd jeopardy class). Clinical manifestations of the acute poisoning included adynamia, lower body temperature, tremor, periodic clonic and tonic convulsions. The chemical has average cumulative ability — cumulation coefficient is 3.03, with moderate irritative action on skin, but no skin resorption and sensibilizing activity, intense irritative influence on eyes mucosa (2nd jeopardy class). Acute inhalation action threshold is 33.9 mg/m 3 . Approximate safe level of exposure to 2-methoxybenzoic acid in the air of workplace is 0.5 mg/m 3 .

Bacterial Otitis by Klebsiella sp. as a Cause of Encephalitis in a Cat

Background: Meningoencephalitis in cats is usually related to infectious diseases but may also be caused by the extension of bacterial infections originated in the middle or inner ear. This paper seeks to report on a case of encephalitis due to an infection in the middle/inner ear in a 15-year-old cat. The diagnosis was made through brain CT scan and culture and antibiogram of material collected during a ventral osteotomy of the tympanic bulla and reported grave intravascular haemolysis associated to the treatment with antimicrobial imipenem with cilastatin sodium that has already been described in humans but not in small animals in the researched literature.Case: A 15-year-old, male, castrated, Siamese cat was brought to the Veterinary Clinical Hospital of the UFRGS. The animal presented pyrexia and hyporexia, tested negative in the immunoenzymatic test to detect antigens of the FeLV and antibodies of the FIV. The animal had a history of three episodes of tonic convulsion within two days and otitis that hadgone untreated for 10 months prior to the consultation, with apparent spontaneous remission. After blood tests, serum biochemistry profile, abdominal ultrasound scan, chest x-rays and CT scan was requested. It revealed middle and inner otitis in the right ear. It was performed a ventral osteotomy of the right tympanic bulla. Material was collected for culture and antibiogram. It was confirmed that the animal had an inner otitis of bacterial origin by multi-resistant Klebsiella spp. that was sensitive only to antimicrobial imipenem with cilastatin sodium. Fifteen days into the treatment with this antibacterial combination, grave haemolysis was observed, probably associated to the use of the medicine. The patient died on the 17th day of the treatment which was not interrupted as per its owner’s decision. At necropsy, both in the tympanic bulla and liver were found mucous content and whitish lumps. The material collected from the tympanic bulla and cerebrospinal liquid were cultured post-mortem when the bacteria Klebsiella sp. was isolated in the CNS and no bacterial growth was observed in the right tympanic bulla.Discussion: This makes it possible to deduce that there was an intracranial expansion of the otitis which would explain the convulsions and, that due to the use of the antimicrobial agent, the growth of Klebsiella sp. in the tympanic bulla was inhibited. The final diagnosis was bacterial otitis with probable bacterial migration to the brain and liver. Suppurativemeningoencephalitis caused by the expansion of the inflammation deriving from middle/inner otitis has been reported as being the cause of convulsions in cats with bacterial isolation. The bacteria that was isolated from the tympanic bulla is in agreement with the microbiota present in middle/inner otitis in cats. Regarding haemolysis, there are no reports thatlink the use of carbapenems in small animals to it or that mention what the safe therapeutic dosage should be if they were administered. Regarding humans, there have been various reports of haemolytic anaemia caused by this type of medicine including carbapenems. It is also known that, in in vitro tests, imipenem may cause inhibition due to competition from human erythrocyte-glutathione reductase, in charge of defending the erythrocyte against haemolysis. It has been concludedthat meningoencephalitis caused by middle/inner otitis must be included as a differential diagnosis in case of convulsions in cats. Additionally, further studies must be carried out in order to determine both the efficacy and the toxicity of carbapenems in veterinary patients, including studies of the occurrence of grave haemolysis after they are administered.Keywords: meningoencephalitis, computed tomography, convulsions, imipinem, carbapenems.

Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children.

Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children.