[Status epilepticus in an asthmatic child]

BACKGROUND

Chronic administration of theophylline can be used for treating asthma; it may represent a severe risk when some other drugs are prescribed by unaware physicians.

CASE REPORT

A 4 yr-8-mo-old boy was admitted suffering from status epilepticus which occurred 3 hours after vomiting. This patient had asthma and was given sustained-release formulation of theophylline and, independently by another physician, two anti-H1 drugs: ketotifen and mequitazine. Serum theophylline concentration measured 9 hours after the onset of vomiting was 28 micrograms/ml; the calculated concentrations were 45.3 +/- 4, 40.2 +/- 4 and 33.4 +/- 4 micrograms/ml after the last administration of theophylline, the onset of vomiting and the onset of seizures, respectively. The patient was given IV fluids plus clonazepam and recovered completely.

CONCLUSION

Severe poisoning can be seen with moderately increased blood levels of theophylline when this drug is chronically administered. Association of other drugs such as anti-H1 could represent an additional risk.

[Febrile convulsions: should some drugs be contraindicated?]

Should certain drugs be contraindicated in children who have had febrile seizures or who present a risk of convulsions? There are no publications dealing specifically with this problem. However, many drugs can induce convulsions and may be dangerous if they are associated with another determining factor (e.g. fever). Camphor known to be toxic and its use must be avoided in young children. Other terpenes given to children with colds may be convulsant if they are used for prolonged treatment or associated with other convulsant drugs (sympathomimetics, piperazine derivatives, antihistamines, etc.). On the basis of a retrospective study of 23 cases of febrile convulsion among 343 cases of infantile convulsion reported to the Poison Control Center and the Pharmacovigilance Center of Marseille between 1973 and 1991, we propose that camphor and sympathomimetics be avoided and that potential convulsant drugs and their association be used with caution. A prospective study is underway to determine responsibility of certain drugs in the occurrence of recurrence of febrile convulsions.

[Role of pharmacovigilance center in information for the public on drugs. Experience in Marseille on 9 month]

We analyzed the role of the Marseille pharmacovigilance center (working in collaboration with the local poison treatment center) in informing the general public on medicinal drugs. Over a 9-month period, the center received 115 requests from members of the public for information. 82.6% of callers were not members of the health professions and wanted information for themselves (61.7%, 67.6% women) or their children (26.08%). The questions mainly involved drug interactions (28.7%), side-effects (26%) and precautions for use in particular circumstances (20%). 178 proprietary drugs (47 of which had been bought over the counter) were mentioned. The main therapeutic classes were neuropsychiatric drugs (n = 41), cardiovascular drugs (n = 17) and analgesics (n = 16). A number of communication difficulties and problems of a deontological nature were encountered. Full information was provided in every case, together with advice on prevention to about half the callers.

[Vasculitis after anti-influenza vaccination. Report of 5 cases]

We describe five cases of vasculitis noted a few days after influenza vaccination. This complication has occurred in four women, and the mean age was 76 years. Although cutaneous biopsy has confirmed leucocytoclasic vasculitis in only one case, the clinical characteristics were evocative in the other cases. No systemic complication were noted. Spontaneous retrocession was noted in four patients and following corticosteroids once. To our knowledge only few cases of vasculitis has been previously reported after influenza vaccination. The mechanisms are unknown but preservatives may have some responsibilities.

Trisomy 12p syndrome: a chromosomal disorder associated with generalized 3-Hz spike and wave discharges

Three cases (2 boys, 1 girl) of trisomy 12p syndrome are reported. In two, the disorder is caused by a malsegregation of a maternal translocation, the karyotype being 46,XY,der(18),t(12;18)(p11;q23) (case 2) and 46,XX,-10,+ der(10),t(10;12)(p15;p11) (case 3). Case 1 is a de novo case with a regular trisomy 12p in the fibroblasts: 47,XY + (12pter----12 cen. . .?) and a mosaic trisomy 12p in lymphocytes: 46,XY/47,XY, + (12pter----12 cen. . .?). In all cases, the EEG showed 3-Hz generalized spike and wave (SW) discharges. Generalized epilepsy with myoclonic seizures was present in two patients (cases 1 and 2), who may be considered to have a symptomatic generalized epilepsy with a specific etiology. Case 3 has shown only febrile seizures. Any association between the excess of genetic material and the EEG trait "generalized SW" might not be a chance occurrence in this disorder; however, both EEG findings and clinical features (seizure type and frequency) in the 23 cases reported in the literature are too scanty to allow confirmation of such an association.

[Psychic effects of drugs prescribed for hypertensive patients. An experiment of the Regional Drug Monitoring Center in Marseilles]

The authors present typical observations of behavioural adverse effects induced by anti-hypertensive drugs and reported to the Marseilles Regional Center of Pharmacovigilance. These effects include: sleep disorders, confusion, psychotic reactions and depression. Surprisingly, these effects seem to be very rarely reported; this is perhaps due to a tricky assessment of the causal relationship: many factors (hypertension, other diseases, other drugs) can have an influence on these troubles.

[Calcified lipogranuloma after gomenoleo oil injection: "paraffinoma" 60 years later]

The authors describe one case of calcified lipogranuloma observed in the forearm tissues of a 67 year old patient. This lesion seems to be due to a long term treatment by S.C injection of gomenoleo oil 60 years before. The analysis by high performance liquid chromatography of fat parts of the lesion identified the original olive oil (excipient).

Familial encephalopathy with permanent periodic breathing: 4 cases in 2 unrelated families

In each of 2 unrelated Algerian families, we observed 2 sisters with a severe static encephalopathy which was detected in the first weeks of life. Anoxia at birth occurred in only one case. This previously unreported familial encephalopathy is characterized by severe mental retardation, hypotrophy, abnormal movements with unprovoked startles, major EEG abnormalities with undifferentiated sleep stages and a very particular periodic breathing pattern that persists during waking and sleep. EEG, polygraphic and video recordings were obtained for all patients. The evolution is chronic and stable. There are no major dysmorphic features. No metabolic or anatomic abnormality was found. Gynecotropy is uncertain and the transmission is likely to be recessive.

[Problems posed by the therapeutic combination of phenobarbital and sodium dipropylacetate. Apropos of a case]

The authors report on the observation of an epileptic woman who showed the clinical and electro-encephalographic symptoms of an overdose of barbiturates when undergoing treatment associating Depakine and Gardenal. Resumption of the treatment results in identical symptoms. The potentialisation of this association and the mechanism by which it acts are as yet unknown.