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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
Walk into any supermarket in Accra, Kumasi, or Tamale today, and you will see the modern Ghanaian diet packaged as ‘progress.’ You will see breakfast cereals with cartoon mascots, fruit drinks that are mostly sugar and colour, and snacks promising energy and happiness in bright fonts.
Even products loaded with salt and unhealthy fats often wear a health halo labeled as fortified or natural, while the real nutritional risk is hidden in tiny print on the back. This is not just a consumer inconvenience; it is a public health blind spot. Ghana is living through a silent surge of non-communicable diseases (NCDs) like hypertension, diabetes, and stroke.
These conditions quietly drain household income and steal productive years. According to the Ghana Health Service (GHS) and World Health Organisation (WHO) estimates, NCDs are now responsible for nearly 45 per cent of all deaths in Ghana.
We cannot build a healthy nation on a food environment designed to confuse people at the point of purchase. Ghana must mandate simple front-of-pack warning labels (FOPWL) on high-sugar, high-salt, and high-fat packaged foods because consumers deserve truth at a glance, and industry must be pushed to reformulate.
Why Back-of-Pack Labels Are Not Enough
In theory, consumers can read nutrition panels. In reality, most Ghanaians shop under pressure, limited time, rising prices, and children tugging at their sleeves. The back label is a relic that requires a high cognitive load to interpret—essentially, the seller knows what is inside, but the buyer cannot easily tell.
This ‘information asymmetry’ is not fair. It is not consumer choice when the information needed to choose well is deliberately difficult to find.
Simple warning labels like the black octagons used in the Chilean Model act as a ‘stop-and-think’ nudge. They do not ban products but they simply tell the truth so people can decide.
Reshaping Our Food Environment
A generation ago, Ghana’s meals were mostly home-prepared, like kenkey and banku with soups and stews. Today, ultra-processed foods have become the norm, especially in urban areas. Children are growing up with sugary drinks and salty snacks as everyday items, not occasional treats.
If Ghana is serious about prevention, we must act where decisions are made—thus, the shelf. Warning labels protect parents from sugar traps and pressure the market to improve. When warning labels are mandatory, manufacturers start to compete to make healthier recipes to avoid the stigma of the label.
Addressing the Pushback
Industry will argue that labels create fear or that education alone is enough. However, health education is slow; labels work immediately. While the informal street food sector is a challenge, regulating pre-packaged goods is the practical starting point because the supply chain is traceable. We cannot wait until the whole system is perfect; we must start where action is feasible.
A 2026 Implementation Roadmap for Ghana
To move from talk to action, Ghana needs this 5-step plan:
- Issue mandatory regulation: The Ministry of Health, Food and Drug Authority (FDA), and Ghana Standards Authority (GSA) must define the label format and nutrient thresholds for all pre-packaged foods.
- Simple, bold symbols: Use plain language and clear symbols, such as “HIGH IN SUGAR,” designed for busy families, not experts.
- Transparent thresholds: Adopt technically defensible standards adapted to the Ghanaian diet.
- Transition and enforce: Provide a 12–18 month period for manufacturers to reformulate, followed by firm enforcement at ports and retail centers.
- National literacy campaign: The Ghana Health Service must pair labels with public messages explaining why high salt or sugar increases disease risk.
Conclusion: Truth Is Not a Luxury
Prevention is cheaper than treatment. A warning label costs little compared to the price of dialysis, stroke rehabilitation, or lifelong diabetes complications. A black octagon on a box of biscuits is more than a label; it is a shield for the health of all Ghanaians. It is time to put the truth where we can see it, right on the front.
By Abigail Amoah Sarfo
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Natives of the Kenkey Kingdom were mad with joy. They were still recovering from the hangover of the kingdom’s loss of the African Cup when their spirits were rekindled. Their great warrior, Zoom Zoom, stormed Melbourne and made sure that every Australian refused food. And that was after he had drawn contour lines on the face of their idol, Jeff Fenech.
Not only did the terrible warrior transform Old Boy Jeff’s face into a contour map useful for geography lessons, but he also accomplished the feat of retaining the much-envied super-kenkeyweight title against all odds. The warrior had not been eating hot kenkey for nothing.
The Fight Against Fenech
When Jeff Fenech bit the dust in the eighth round, I was tempted to consider if Adanko Deka could not have faced him in any twelve-rounder, title or non-title bout. Adanko has improved tremendously, and soon he would be facing Pernell Whitaker.
Sincerely, I was pessimistic about Azumah’s man, who the last time took him through twelve grueling rounds of rough boxing. I expressed my fears to my colleague Christian Abbew, alias Gbonyo, who surprisingly had total confidence that the Australian brawler would fall, predictably in Round Five.
Gbonyo gave reasons for his contention, all of which I counteracted using the age factor. Fact is, I didn’t know that contrary to the laws of nature, Azumah was all the time growing younger.
When Fenech fell briefly in round one, I asked my brother whether it was the same Fenech that fought Azumah in Las Vegas. Sure, it was the same Fenech, all out to beat Azumah before his countrymen.
But the African Professor had no intention of making the Australian a hero. As he spun round the desperate Aussie, dancing and stinging out his jabs, it was not too long before I realized that the end was near.
The Eighth Round Showdown
Two minutes into the eighth round, the African ring-master proved to the whole world that he was a true son of Bukom. He himself was cornered, but like the tough nut he is, he managed to break free before overwhelming the panting Australian with several blows that made him crash headlong.
Moments after, the referee, expressing fatherly sympathy, stopped the fight to prevent an obituary. After the ordeal, Fenech’s fairly handsome face was full of newly constructed hills, valleys, ox-bow lakes—whatever. I noticed that his nose was very tired and had a miniature volcano sitting restlessly on it. Obviously, Jeff’s wife will have to nurse that nose back to its normal shape—but I’d advise her not to use iodine, otherwise her dear husband will wail like a banshee.
Reflections on Boxing
Because Mohammed Ali was the kind of boxer kids liked, many school-going kids often entertained the wish of becoming like him. I remember one day when I told my father I wanted to become a boxer, and he advised me to first complete my education to the highest level. Then, if I decided to become a boxer and was knocked out a couple of times, I’d fall back on my degrees and make a living.
Boxing used to be interesting when bouts were fought more with the mouth and tongue than with gloves. You had to brag well, psychologically belittling your opponent before beating him up physically. Mohammed Ali became a very successful pugilist because he also managed to become a poet. He often blew his horn across America, calling himself the “pretty boxer” and opponents like Joe Frazier “the gorilla.”
Ali made a living fighting hard fists like Joe Frazier, Ken Norton, Jerry Quarry, George Foreman, Leon Spinks, and Trevor Berbick. Twice he came back from retirement to fight just for money. It was Larry Holmes who finally pensioned him, and since then the great Ali has never been himself.
The Path Ahead for Azumah
When Azumah nailed Jeff Fenech on the cross and barked almost immediately that he was after the head of Pernell Whitaker, I was happy but concerned. I would have been happier if he had announced his resignation there and then—he would have been more of a hero. Beating Fenech in Australia is more newsworthy than facing Whitaker in the States.
With Whitaker, it might be a little difficult. The “Sweet Pea” is agile, has a crooked body like a snake with diarrhea, and stands awkwardly as a southpaw. He is known for having the fastest pair of fists and the rare ability to dodge punches no matter how close they may be.
Much as I do not doubt that Azumah can take his title, I also don’t want him to retire beaten. I want him to retire as a hero and live a fuller, healthy life.
As Azumah himself said after dishing Fenech, he is now a professor and has something to show for it. Like a true professor, I think it is time he resigned and took up training young talents who could draw inspiration from him and become like him in the future.
Closing Thoughts
I must say that although ageing boxers like Larry Holmes and George Foreman are making a name for themselves, boxing is not like the Civil Service, where you can even change your age and retire at 74. Zoom Zoom has delighted the hearts of the natives, and Sikaman will forever hold him in high esteem—but only when he retires as a hero.
This article was first published on Saturday, March 7, 1992.
