Abstracts

RATIONALE: With the plethora of recently released anticonvulsants, uncontrolled seizure frequency often leads to a change in prescribed anticonvulsant. What may be overlooked in this rush to use the newer agents are the fundamentals in seizure control -- compliance, therapeutic blood levels, and the avoidance of threshold lowering behaviors (decreased sleep, excess stress, medications, and caffeinated beverages).
METHODS: Retrospective case analysis with review of literature.
RESULTS: A 49-year-old white male with a 36-year history of mixed seizure disorder who had been well controlled on phenytoin 400mg qd and primidone 500mg qd developed a sharp increase in myoclonic and atonic seizure frequency. Anticonvulsant compliance had been maintained with therapeutic blood levels. There had been no change in sleep patterns or level of stress. Change in anticonvulsants to newer agents was contemplated. Prior to doing such, a review of the patient[ssquote]s diet revealed a recent increase in caffeinated beverages. In an effort to avoid caloric beverages, the patient was drinking 2 quarts of [dsquote]Peach diet Snapple Iced Tea[dsquote] daily. The increased seizure frequency continued over a two month time period until the beverage was changed to decaffeinated [dsquote]Kiwi Strawberry diet Snapple Juice Drink.[dsquote] This simple change in diet obviated the need to change anticonvulsants to control seizure frequency.
CONCLUSIONS: There is a significant literature supporting the proconvulsive effects of methylxanthines [1. Czuczwar SJ, Gasior M, Szczepanik B, et al. Influence of different methylxanthines on the anticonvulsant action of common antiepileptic drugs in mice. Epilepsia 1990; 31:318-323. 2. Coffey CE, Figiel GS, Weiner RD, et al. Caffeine augmentation of ECT. Am J Psychiatry 1990; 147:579-585. 3. De Sarro A, Grasso S, Zappala M, et al. Convulsant effects of some xanthine derivatives in genetically epilepsy-prone rats. Naunyn Schmiedebergs Arch Pharmacol 1997; 356:48-55. 4. Gomes A, Das M, Vedasiromoni JR, et al. Proconvulsive effect of tea (Camellia sinesis) in mice. Phytother Res 1999; 13:376-379. 5. Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet 2000; 39:127-153] that must be considered when addressing seizure control. The authors feel that the newer anticonvulsants are important to control epilepsy and in many instances have better side effect profiles than the older agents. Nonetheless, the use of these agents does not permit the practitioner and the patient to forget the fundamentals in epilepsy control, specifically minimization of seizure threshold lowering behaviors including excessive caffeinated beverages.
Support: There was no funding support associated with this paper.