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Tiagabine Overdose Can Induce Convulsive Status Epilepticus

Tiagabine (Gabitril, TGB) is the first -aminobutyric acid (GABA) uptake inhibitor introduced as adjunctive therapy for refractory partial seizures (1). The effective dose range is 32–56 mg daily, and the dose range as monotherapy is likely to be lower. Therapeutic monitoring of plasma concentration of TGB is not recommended. TGB is considered to be an effective anticonvulsant medication (AED) and appears to lack serious adverse reactions. However, as of September 1996, 13 patients in a total of 2,531 in the literature, who received the medication had mental-status changes and EEG findings suggestive of nonconvulsive status epilepticus (NCSE) (2–8). The TGB dose in these reports was within the therapeutic range, but blood levels were not obtained. Review of data confirmed the diagnosis of NCSE in three of 13 patients (8). In the remainder, clinical and EEG findings were attributed to TGB intolerance secondary to high dose (8). When the TGB dose was reduced clinical symptoms resolved. We describe the first case of convulsive status epilepticus (CSE) induced by TGB overdose.