Features
MEDICINES AND RISK OF LOWERING THE SEIZURE THRESHOLD
I am on medications for seizures. Recently I was diagnosed with a urinary tract infection and put on Ciprofloxacin. It was changed when my details showed a history of seizures. Kindly shed more light on this issue. Yes, it is true that Ciprofloxacin can lower the seizure threshold and therefore could precipitate a seizure for someone with a history of seizures and taking medications.
A seizure is the clinical manifestation of abnormal, excessive or synchronous neuronal firing in the brain. The clinical features of seizures may include abnormalities of consciousness, movement, sensation, behaviour and autonomic function. Epilepsy is the enduring tendency to experience seizures. The seizure threshold describes the minimum intensity of a stimulus required to induce a seizure. It is clinically evident in the context of electroconvulsive therapy, but is otherwise primarily an experimental phenomenon, in which seizures are induced by electrical or chemical stimuli.
Seizures occur when there is an excess of excitatory activity relative to inhibitory activity. Glutamate and gamma-aminobutyric acid (GABA) are, respectively, the principle excitatory and inhibitory neurotransmitters in the central nervous system (CNS). Glutamate acts via N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) and kainite receptors to cause an influx of sodium and calcium ions, favouring depolarization. GABA acts primarily through GABAA receptors to cause an influx of chloride ions, inducing hyperpolarization. The mechanisms of action of antiepileptic drugs include interference with sodium (e.g. phenytoin, carbamazepine, lamotrigine) and calcium channels (e.g. ethosuximide); enhancing the effects of GABA(e.g. benzodiazepines); antagonizing glutamate at AMPA receptors; and a combination of these effects (e.g. valproate). Drugs with the opposite effects may induce seizures.
Seizure potential is often evaluated during drug development to quantify the extent to which a drug prevents seizures (if this is the intended therapeutic effect) or induces them (as an unwanted effect). As a broader concept, it is useful in clinical practice as a framework to help understand the complex interplay between the patient, their medicines, and their risk of seizures (Hitchings .W. Drugs that lower seizure threshold. St George’s, University of London and St George’s University Hospitals NHS Foundation Trust. Thundiyil JG, Kearney TE, Olson KR. Evolving epidemiology of drug-induced seizures reported to a Poison Control Center System. Journal of Medical Toxicology 2007;3:15-9).
The propensity of a drug to induce seizures depends on its effects on neurotransmission and their timecourse (e.g. whether it increases seizure risk during use or on withdrawal), the concentration of drug reaching the brain, and the susceptibility of the individual patient. Susceptibility factors include previous seizures, structural or functional brain abnormalities, and concurrent drug use. In the face of such complexity, it is rare that seizures can be ascribed primarily to the effects of a drug (i.e. ‘drug-induced seizures’). Commonly, however, drugs contribute to a shift in excitatory/inhibitory balance which, in that individual at that time, leads to a seizure. In this respect, it is generally more helpful to regard such drugs as having lowered the seizure threshold, rather than having incited seizures.
Many drugs have indirect effects on the seizure threshold, for example by inducing hypoglycaemia, electrolyte disturbances or respiratory depression, or by interacting with antiepileptic therapy. Drugs with potential to lower the seizure threshold are numerous and diverse. Whether they contribute to clinically overt seizures depends on the dosage in which they are taken, the time-course of their effects, and the susceptibility of the patient. It is important to add that the contribution of medicines to seizure risk is potentially modifiable. For antimicrobials, the beta-lactams (penicillins, cephalosporins and carbapenems), interact with the GABAA receptor to interfere with the inhibitory effects of GABA in a concentration-dependent manner. Correspondingly, they have dose-dependent effects on the seizure threshold. However, the CNS penetration of penicillins and cephalosporins is relatively low. As such, most reports of seizures associated with these agents emerge from their use in high doses (often in the treatment of CNS infections) or in renal failure. Carbapenems more readily penetrate the CNS and their use is associated with an increased seizure risk compared with non-carbapenem antibiotics. Among the carbapenems, imipenem is generally regarded to have the highest risk. However, this may be because studies conducted on the newer agents (meropenem, ertapenem and doripenem), informed by earlier experience with imipenem, generally excluded patients with a history of seizures. All cephalosporins have the propensity to lower the seizure threshold but the one often associated with this phenomenon is cefipime. The quinolones are another group with the most common ones being ciprofloxacin and levofloxacin.
The antituberculous agent isoniazid inhibits pyridoxine phosphokinase, the enzyme which converts pyridoxine to its active form, pyridoxal-5-phosphate. Pyridoxal-5-phosphate is an essential cofactor in the synthesis of GABA from glutamate. The resulting fall in inhibitory activity and rise in excitatory activity leads to a dose-dependent reduction in the seizure threshold. Isoniazid toxicity is characterised by a triad of altered mental status, metabolic acidosis and refractory seizures. Treatment with pyridoxine and a benzodiazepine usually results in prompt seizure termination.
The antimalarial agents mefloquine and chloroquine can precipitate seizures in people with epilepsy. This effect has been reported even in healthy individuals.Antipsychotics are another group with the most common ones being chlorpromazine and clozapine. Some antidepressants also have this tendency with the notable ones being Amitriptylline and Venlafaxine..Seizures are common in cases of antidepressant overdose, particularly with venlafaxine and TCAs.
Narcotics such as Meperidine, Fentanyl and tramadol have also been associated with lowering of the seizure threshold.Many drugs can adversely affect the seizure threshold, although whether this leads to overt seizures depends on the concentration of drug reaching the brain, the susceptibility of the individual to its effects, and how these effects vary over time. In managing patients with epilepsy or other risk factors for seizures, one must be mindful of the potential for medications to lower the seizure threshold, so as not to precipitate avoidable seizures. Likewise, in evaluating patients with seizures, consideration must be given to the seizure-provoking potential of their medications. As noted by Hitchings information on the intended medicine’s risk to lowering the seizure threshold becomes an important factor in the decision to withhold or stop the medication to improve seizure control or prevent it in the first place.
As always use medicines safely. Always consult your pharmacist on safe use of medicines.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
Features
Attempts to kill natural therapy?

Anyone who has the devil’s benediction of getting sick of diabetes and jaundice at the same time would surely blame an experienced witch for his or her palaver. Fact is, the combination is a dreaded one with the form and visage of an obituary.
The bio-chemical analysis of the unholy combination is, however, within arm’s reach. Diabetes doesn’t tolerate sugar and jaundice can’t get cured without glucose (sugar). The two diseases are therefore irreconcilable under any medical condition. They are just not of the same womb!
So the terrified patient has to choose between two styles of dying: either curing the diabetes or dying of jaundice or curing the jaundice and falling into a diabetic coma en route to a cold room transit. The next available plane is destined for the cemetery, meaning the world no longer has any business to do with you.
Now, forgetting about pathological combinations and narrowing the focus on diabetes, one can still crumble in fear. The reason is that diabetes as a disease is not a benevolent ailment. We can understand this because it has never been philanthropic in any sense of the word. It demands its pound of flesh, and that is often worth a human life.
The problem is that, if you have too much sugar in your blood (hyperglycemia), you risk falling into coma. If your sugar level is also too low, a terrible coma awaits you. You just can’t understand the malevolence associated with the disease so you have to keep a balance.
TREACHERY
I am writing this piece because of the sundry sinister attempts of treachery, overt and covert, being subtly perpetrated to kill Natural Therapy which claims a cure for diabetes. The claim is completely at variance with the assertion of orthodox practitioners who believe that diabetes can only be managed, but can never be cured.
Basically, diabetes occurs when the pancreas is not producing enough insulin to cope with blood sugar, or is not producing insulin at all. The result is a debilitating disease with several complications that can lead to death.
To combat the disease, one has to be put on diaonil or daily insulin injections supposedly to manage the disease, not to cure it because according to medical gurus, it cannot be cured.
Natural therapists have a different and more progresso-radical view. They say diabetes can be cured and they are proving it every day of the week. Happily, medical doctors who develop diabetes are now coming for natural therapy, albeit under the cover of darkness. Today, there are many living testimonies of a natural therapy cure for the deadly ailment.
I was really sad about a silly attempt to frustrate the efforts of a well-known Texas-trained naturopathic physician who has toned down the orthodox medical chorus that diabetes is not cur-able. Many of his patients who had been on insulin for years before seeing him are off it.
The medical crusade is a veritable one, and the good news is being propagated by those who have seen the light. Dr Kwesi Ofei-Agyemang’s success story is one that needs to be told from the roof-tops. But ask me, how is he being frustrated?
On October 28, 1996, a diabetic patient of Dr Ofei-Agyemang had her sugar level checked. It was 6.1 mmo1/1. After treatment using naturopathic methods, she became well and was asked to check her sugar level again at a laboratory (name withheld) on 6-11- 96. Surprisingly, the lab recorded 13.3 mmol/l; meaning that her situation had worsened by far.
When she brought the report, Dr Ofei-Agyemang was sceptical about it. The patient was supposed to have recovered, or at least was recovering. The level could, therefore, not be 13.3. He rushed to the laboratory to demand an explanation.
When Dr Ofei-Agymang queried the report, the technician said he was sorry and added that he’d investigate the error.
Meanwhile at another laboratory where he sent the patient for another test to cross-check the earlier result, the patient’s sugar level recorded a low 2.9 mmo1/1, a correct reflection of her improved state of health.
The doctor was furious for a very good reason. If he had taken the earlier lab report seriously and continued treatment to further reduce the patient’s sugar level, the patient would have sunk into coma and possibly died.
“This is not the first time this is happening,” Dr Ofei-Agyemang told me in an interview last week Friday. When I send my patients for tests, some lab technicians deliberately don’t return the correct results just because they know the patient is attending a natural therapy clinic.
“I see it as a subtle attempt to kill naturopathy in this country aside other hidden strategies that are being adopted to sabotage it. They are all out to create a wrong impression in the minds of patients that they are going to the wrong place for treatment when in fact they are at the right place.”
Other attempts include doctors warning their patients never to submit themselves to natural therapy whenever the patients suggest they want to try it, knowing well that orthodox medicine isn’t helping them.
Look at something else like this one. After Dr Ofei-Agyemang had cured one patient of a disease and placed him on a diet of fruits and vegetables, the patient’s brother (a doctor) advised him to quit the natural diet regimen and to eat plenty of meat and all that has to do with balanced diet.
So the patient quit the natural diet and ate meat to his fill. Before long boils broke out all over his body. Apparently, the body was rejecting the unnatural diet which had become toxic to the body following the spell of natural dieting.
FAILURE
I have been thinking about this diabetic cure controversy for some time now. I was compelled to ask the natural therapist to explain how naturopathy could possibly tread where orthodox medicine has woefully failed as far as a cure to diabetes was concerned.
He explained that a defective pancreas only needs to be revived through selective manipulation, diet and urine therapy to make it function again. If defects in other organs of the body can be corrected, there should be no medical reason why the pancreas should be an exception, he said.
“What other doctors must know is that once our methods are different, our results will naturally be different,” he said. “What they are supposed to be saying in fact is that ‘according to orthodox medicine, there is no cure for diabetes.’ They should stop saying there is no cure for diabetes because we are curing it. If they doubt it they should come here and see things for themselves.
“Our methods are natural and include colon irrigation, deep tissue massage which is more effective than physiotherapy, diet, some fast and manipulation, and urine therapy. There is no way any disease can survive a combination of these methods.
Cancerous sores and all kinds of chronic ailments have been cured, diabetes inclusive.
“We just rejuvenate the dormant pancreas and it starts producing insulin. Unless the pancreas is cut out through surgery as a result of cancer, we have ways of making it work.”
I spoke to one of his patients, Jamison Ocansey. He was sick of diabetes and has been on herbs of all kinds, insulin and dioanil for more than a year. His sugar level fluctuated between 9 to 17 mmo1/c. After treatment, his sugar level is between 5.0 and 5.9 mmol/c.
“People don’t like this method because of the urine that is included in the method of cure,” he said.”I used to feel the same way but as I’m now cured, I’ve an entirely different opinion. Let me also thank your paper Weekly Spectator. It was an article in it that made me come here, so keep spreading the message.
“I used to be very weak and couldn’t walk. Look, now I am as strong as a bull. I eat well and I’m happy.”
The doctor has cured various types of diseases at his clinic which is 100 metres north of Holy Gardens or Lido, Circle, Accra. What I believe would help us all is that the medical authorities should investigate these cures and come out openly to claim or disclaim them.
Those who are off insulin would also give testimony. That way, natural therapy can become more acceptable and there would be no point in anybody trying to frustrate efforts at entrenching it as the better substitute that has no side effects. It should in fact be the ideal complement to orthodox medicine and not an adversary as people want to portray it.
This article was first publish on Saturday, November 16, 1996
Merari Alomele’s
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The problem is that, if you have too much sugar in your blood (hyperglycemia), you risk falling into coma. If your sugar level is also too low, a terrible coma awaits you. You just can’t understand the malevolence associated with the disease so you have to keep a balance.
Features
It is great to be young
If I had the power, I believe I may be tempted to remain a child forever. We used to hear statements it is great to be young when growing up.
I did not really comprehend one anybody would wish to be like me, a small boy and not wish to be an adult like my Dad. Those were the days that the family did not sit around a dining table and your Dad’s meal was set up on a small table at a particular spot in the hall.
When I observed the amount of meat that were given to my Dad and what was given to me, l definitely wanted to grow up quickly to also become an adult. Therefore to hear some adults occasionally declare that it is great to be young, was something I could not understand.
My reasoning was that, adults were enjoying a lot of benefits and so for any adult to even consider the possibility
When I grew up however, I have come to appreciate that saying that indeed, it is great to be young. Growing up as a child, all l looked up to was the next day to come as I go to bed. When I woke up, l had no worries about what I would eat before going to school.
Where the next meal was going to come from was not my concern. All l had to do was to make sure that I go to school, study hard and pass my exams and ensure that I am within the first three, in my class. There was no worrying about school fees, changing of school uniforms or clothes in general, something I cannot run from now as an adult.
I now have to provide for some people now and I can now fully understand my Dad’s comment that it is great to be young.
Christmas time was a very interesting and exciting time as a child because new clothes were provided for me and my siblings. I recall one Christmas period when I was provided with a suit. It was a memorable occasion in my life as it was the first time I wore a suit.
I felt very proud wearing the suit and with my new shoes to match, I felt great walking with my friends as we moved from place to place. When a new academic term begins I always looked forward to having a new school uniform. How much it was going to cost or how it was going to be provided was not my concern at all. It was taken for granted that I will get a new uniform at all cost.
I always had a good night’s sleep with the exception of those days that I was suffering from malaria and I had quite a number of such malaria attacks.
Recently my last born jokingly said “Daddy, do not think that I am not going to take money from you when I grow up oh. Even when I get married and have children, do not think you will be free. I will still collect money from you because you are my father”.
I burst into laughter and said “It is great to be young”. At the moment, her needs are provided by me and until she completes school and starts working, I will continue to provide for her needs. There have been moments that I wish I were a child once again.
I recall an incident involving my little girlie as I affectionately call my last born, when she pushed a piece of chalk into her nostril and we had to take her to the hospital, and wondering how it was going to come out. While her mother and I were worried at the hospital, she did not seem bothered and in that moment I wished I was a child. When the nurses finally got it out, I was so relieved and she was just smiling, obviously not worried as I was. Indeed, it is great to be young.
NB: ‘CHANGE KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT’
By Laud Kissi-Mensah