Management of the main underlying cause is essential in addition to anticonvulsant therapy (Panel 2 ). Panel 1 Potential causes of seizures Organ failure Altered homoeostasis due to (multi) organ failure Underlying disorder causing organ failure such as systemic lupus erythematosus, chronic alcohol abuse Dialysis, electrolyte, or other metabolic disturbance Ischaemic, hypoxic, or hypertensive encephalopathy Raised blood concentrations of proconvulsant medications due to reduced clearance (eg, some antibiotics) Postoperative Anaesthetic-related Inadvertent drug and alcohol withdrawal Electrolyte and glucose disturbance Underlying systemic disease, such as porphyria Organ failure Intensive care Medication-related (eg, pethidine) Narcotic and other drug withdrawal Organ failure and ischaemic-hypoxic encephalopathy Metabolic disturbance Sleep deprivation and multifactorial causes Emergency admissions Alcohol-related Illicit drug use (eg, cocaine, MDMA) Other infection (eg, HIV, malaria) After cardiorespiratory arrest Toxin exposure (eg, carbon monoxide poisoning) Cancer and transplant patients Parenchymal and leptomeningeal metastases Opportunistic infection Metabolic abnormalities Immunosuppressive therapy (eg, cyclosporin tacrolimus) Chemotherapy-related Panel 2 Principles of seizure management in patients with medical illnesses • Stabilise patient and attend to airway, breathing, and circulation • Obtain intravenous access, monitor vital signs, and arrange routine and special laboratory tests • If seizure does not stop within 5–10 min, treat as status epilepticus (usually with a combination of intravenous phenytoin or fosphenytoin and benzodiazepines as first-line therapy) • Rule out intrinsic nervous-system abnormality with clinical assessment, spinal-fluid examination, neuroimaging, and special studies as indicated • Obtain reliable collateral history where appropriate • Consider psychogenic or non-epileptic seizures • If non-convulsive or subtle status epilepticus is likely, do early electroencephalography • Consider unusual presentation of a systemic disorder (eg, sarcoidosis, porphyria) • Obtain drug history and check all currently taken medications (including investigational drugs) • Consider inadvertent or unrecognised drug or alcohol withdrawal • Consider illicit drug use • Obtain history of possible environmental exposure to proconvulsant toxins • If history of poorly controlled hypertension (eg, in patient with end-stage renal disease), or if blood pressure remains high 1–2 h after seizure activity starts, hypertensive encephalopathy may be the cause • Correct all underlying potential causes as early as possible • Prescribe specific antidotes (eg, intravenous pyridoxine for refractory alcohol-related seizures) For systemically ill patients with seizures it is important to exclude a primary neurological cause. The analgesic tramadol has been reported to cause seizures in 8% of patients in overdose (>500 mg).39 Other medications that may cause seizures include chemotherapeutic agents such as etoposide, ifosfamide, and cisplatinum, and antimicrobial agents.28 L-asparaginase can cause seizures by inducing sagittal sinus thrombosis, an effect mediated by an acquired antithrombin-III deficiency.40 Withdrawal from baclofen is known to cause seizures, but this drug, which acts at the GABAb receptor, has also been reported to cause non-convulsive status epilepticus.41 Propofol is increasingly used to treat refractory status epilepticus,42 but can also cause non-epileptic subcortical myoclonus in some cases.43 All medications should be reviewed and considered as causative or exacerbating agents in the pathogenesis of new-onset seizures.

Serum homocysteine levels may be a marker of the risk of alcohol withdrawal seizures (Bleich et al., 2004 ). The other effects of long-term alcohol abuse, such as hypokalemia (Chen et al., 2006 ), complications of head injury (Rathlev et al., 2002 ), and clotting problems with cerebrovascular hemorrhage (Rathlev et al., 2002 ), lower seizure threshold and increase the chances of prolonged or sustained seizure activity. All age groups are at risk, including the elderly (Kraemer et al., 1999 ). Chronic GABA potentiation may change subunit expression, allowing additional hyperexcitation on alcohol withdrawal and increasing the seizure risk (Hillbom et al., 2003 ). Furthermore, alcohol withdrawal increases the QT interval, maximal at 6–48 h after stopping, and thereby increases the risk of sudden unexpected death in epilepsy (SUDEP). In addition, the theoretical risk of kindling may induce seizure activity by withdrawal via neurologic changes that predispose to seizure induction by future diminishing stimuli (Pinel, 1980 ). Clinical effects of alcohol toxicity.

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Abstract In the last decade, a global trend of escalating ecstasy (MDMA, MDA, MDEA, MBDB) use was observed. Mentions on medical death certificates, last year's ecstasy use, number of drug offenders, seizures, prices and dosage levels figures were used for this descriptive and correlational study.

“Clean” Ecstasy tablets, containing pure MDMA, are often considered to be safe (4). There may be a relationship between serum concentrations and toxic effects of MDMA, but a case report of survival after Conclusion Hyperthermia caused massive rhabdomyolysis in our patient, and despite rapid active cooling and drug therapy, the hyperkalemia due to this rhabdomyolysis was unresponsive to treatment. Cited by (21) Isolated non-cardiogenic pulmonary edema — A rare complication of MDMA toxicity 2017, American Journal of Emergency Medicine The dose of MDMA in a tablet of ecstasy varies greatly, up to 70-fold [7], and there is also a difference in individual response to a dose of MDMA leading to inadvertent overdoses [9]. While ecstasy or Molly contaminated with adulterants are known to cause deleterious toxic effects, pure MDMA ingestions had been considered safe after case reports of survival following ingestions of high concentrations of MDMA [9,24,25]. However, case reports do indicate that fatalities occur after pure MDMA ingestions as well, likely secondary to hyperthermia, severe rhabdomyolysis and resultant hyperkalemia [9]. Methamphetamine and MDMA: 'Safe' drugs of abuse 2014, African Journal of Emergency Medicine The use of mannitol is not a currently standard treatment.

School of Pharmacy, University of California-San Francisco Search for more papers by this author Dr. Its appeal involves its euphoric effects and a feeling of empathy for others (hence the nickname “hug drug”). This appeal may be furthered by a misleading and anecdotal perception of safety.

The classification of these drugs as illicit, controlled substances in the United States has not prevented their use, and MDMA, or Ecstasy, is currently one of the most popular substances used recreationally in North America. A look at the history of these compounds suggests that they have the potential to be used safely as psychotherapeutic tools, and that the legal status of MDMA and MDA may be worth reconsidering.

The aim of this study was to investigate the possibility of prioritising techniques utilised at the Australian Federal Police (AFP) for the chemical profiling of 3,4-methylenedioxymethylamphetamine (MDMA). The outcome would provide the AFP with the ability to obtain more timely and valuable results that could be used in an intelligence perspective. The results showed that gas chromatography–mass spectrometry (GC–MS) was well suited as a single technique to detect links between seizures and could be used in priority for operational intelligence purposes.