Abstracts

Rationale: Energy drinks (EDs) are popular amongst adolescents and young adults, but they are not without risk. Although seizures have rarely been reported as a consequence of EDs abuse, we did not find any cases of status epilepticus (SE) linked to EDs in the literature. Methods: Single case report. Results: An 18 year old man is admitted to the hospital after three witnessed generalized tonic clonic seizures. He has been previously healthy, except for some abdominal discomfort and intermittent diarrhea for few days prior to admission. Despite initial improvement after receiving levetiracetam, the patient's level of consciousness declined after 24 hours and he started exhibiting intermittent lip smacking and facial twitching. An EEG revealed recurrent focal seizures of independent bihemispheric origin (left more than right), fulfilling the criteria for non-convulsive SE. Seizure control required multiple high dose antiepileptic drugs, intubation and sedation with midazolam then propofol. Four days later, sedative drugs were discontinued and the patient extubated, with gradual recovery and no seizure recurrence. The brain MRI showed bilateral symmetrical areas of restricted diffusion along the medial temporal lobes involving the amygdala and hippocampi with increased T2/Flair signal without contrast enhancement. Detailed investigations failed to reveal any infectious, toxic, metabolic or autoimmune etiologies for the SE. The patient later admitted to drinking six EDs of variable sizes and brands daily, prior to admission. He denied concomitant alcohol intake. Five months after discharge, with the patient abstinent from EDs, he has no complaints and a normal neurological examination. His repeat EEG is normal, and MRI shows resolution of the signal abnormalities. Conclusions: This case illustrates a potential link between high volume consumption of EDs and new-onset SE, in a patient with no other risk factors for seizures and no other identifiable causes for the SE. The patient made a full recovery, with no seizure recurrence after cessation of EDs. Few reports of new onset seizures linked to EDs exist in the literature, but to our knowledge, this is the first report of SE in the context of EDs abuse. The pathophysiology for such occurrence can only be speculated; EDs are rich in stimulants and taurine. Chronic administration of the later was shown to increase susceptibility to seizures in animal models. In humans, seizures have been documented following caffeine overdose. The public and care providers should consider the potential ill effects of EDs heavy consumption, including possible links to seizures and even SE. Since the contents of EDs are not typically tested in routine toxicology screening panels, physicians should inquire about such intake when faced with new onset seizures and SE without an obvious etiology. Funding: none