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The true incidence of drug-induced seizure is very difficult to determine, however, a nice poison center study attempted to determine clinical factors associated with complications (potentially life-threatening) of drug-induced seizures. They found 3 predictors that demonstrated statistically significant associations:
- Stimulant Exposure (i.e. cocaine, amphetamines etc)
- Initial acidosis
- Hyperglycemia (limitation they do not give incidence of DM)
They found a 60% complication rate in drug-induced seizures which is much higher than epileptic seizures. Makes sense since these patients are often sedated/altered or vomiting.
Stimulant Exposure is much more prominent in this population and has increased in mortality.
Interesting point with hyperglycemia, may be a novel marker for poor prognosis. Several studies have confirmed an association between hyperglycemia and increased neuronal injury and mortality in other settings like CVA and TBI.
Take home point - Drug-induced Seizure has a high complication rate in the ED. Watch for the 3 predictors as that may clue you in to the increased risk.
References
Thundiyil JG et al. J Med Toxicol (2011) 7:16-23