Theophylline-induced seizures: Clinical and pathophysiologic aspects

Focal-onset generalized motor seizures are a manifestation of theophylline toxicity that necessitates prompt theophylline dosage adjustment. Anticonvulsant therapy is not effective in controlling the seizures and may delay appropriate therapy, as will investigation for a structural brain lesion. These seizures tend to be the only sign of theophylline toxicity, usually occur in neurologically intact patients and leave no or only minor neurologic sequelae if controlled early. Electroencephalography done during seizure activity typically shows periodic lateralized epileptiform discharges or similar activity. Heightened endorphin activity may be the predisposing factor of theophylline-induced seizures, suggesting the possibility of treating this distinct metabolic encephalopathy with an endorphin antagonist. However, much remains to be clarified.