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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
Introduction
In today’s fast-paced, high-achieving society, it’s common to glorify long hours and an unwavering commitment to one’s profession. However, when dedication turns into an obsession, it can have severe and far-reaching consequences.
Workaholism, a pattern of behavior characterised by excessive and compulsive work habits, is a complex and multifaceted issue that affects millions of people worldwide.
Defining workaholism: The Psychology behind the behavior
Workaholism is often driven by a combination of internal and external factors, including:
Internal Pressures:
Perfectionism: an unrelenting drive for flawlessness
Fear of failure: anxiety about not meeting expectations
Need for control: a desire to micromanage every aspect of work and life
External Pressures:
Job demands: high expectations from employers or clients
Organisational culture: a workplace environment that encourages or demands excessive work hours
Societal expectations: pressure to succeed and maintain a certain status
The health consequences: A growing concern
Prolonged workaholism can lead to a range of serious health issues, including:
1. Cardiovascular problems: hypertension, heart disease, and stroke due to chronic stress and neglect of physical health
2. Mental health concerns: anxiety, depression, and burnout, often exacerbated by lack of social support and self-care
3. Sleep disorders: insomnia, sleep deprivation, and related health issues, such as impaired cognitive function and mood disturbances
4. Immune system suppression: increased susceptibility to illnesses, such as colds, flu, and autoimmune diseases
5. Nutritional deficiencies: poor eating habits, weight changes, and related health problems, such as diabetes and cardiovascular disease
The lethality risks: A hidden danger
In extreme cases, workaholism can have lethal consequences, including:
1. Sudden cardiac death: increased risk due to chronic stress, hypertension, and neglect of physical health
2. Suicide: work-related stress and pressure can contribute to suicidal ideation, particularly in individuals with underlying mental health conditions
3. Accidents and injuries: fatigue and decreased cognitive function increase the risk of workplace accidents and errors
The social and emotional toll: Relationships and identity
Workaholism can also have devastating effects on personal relationships and overall well-being, leading to:
1. Strained relationships: family, friends, and colleagues may feel neglected, abandoned, or resentful
2. Loss of personal identity: over-identification with work can lead to a loss of interests, hobbies, and sense of purpose outside of work
3. Decreased productivity: burnout and decreased motivation can result in reduced job performance and satisfaction
4. Impaired cognitive function: decreased creativity, problem-solving, and decision-making abilities due to chronic stress and fatigue
Breaking the cycle: Strategies for recovery
Recognising the signs of workaholism is crucial to preventing its negative consequences. Strategies for overcoming workaholism include:
1. Setting boundaries: establishing a healthy work-life balance and prioritising self-care
2. Prioritising self-care: engaging in activities that promote physical and emotional well-being, such as exercise, meditation, and social connections
3. Seeking support: therapy, support groups, and social connections can provide emotional support and guidance
4. Re-evaluating priorities: reassessing values and goals to align with a more balanced and fulfilling life
Conclusion
Workaholism is a serious issue that can have severe and far-reaching consequences for individuals, organisations, and society as a whole. By acknowledging the risks and taking proactive steps to maintain a healthy work-life balance, we can mitigate the negative effects of workaholism and promote overall well-being.
By Robert Ekow Grimmond-Thompson
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How many times have we not made New Year resolutions but have not been able to achieve them?
When we are unable to achieve them we vow to ourselves that at the end of the year, we shall make proper New Year resolutions and this time we will make it happen only for the New Year to travel on and close to the end the story repeats itself.
A lot of people find themselves in this situation and if they were to rate their success, it may hover around 48 per cent. There is a popular quote that is generally attributed to Einstein that” Insanity, is doing the same thing over and over again and expecting a different result.
“A careful analysis will most likely reveal that, the discipline required to put in the required effort and the consistency required is absent in the execution phase of whatever plan has been put in place to realise the objectives.
Discipline according to the Oxford Dictionary is the practice of training people to obey rules or a code of behaviour, with punishment or other undesirable consequences for those failing to comply.
When we say someone is disciplined, what can be observed in his behaviour is consistency whether it is in connection with reporting for events on time, providing a particular service as promised on schedule etc.
In other words, that behaviour has become routine or has become a habit. If 2026 is going to be different from the previous years, as far as the achievement of New Year’s resolutions are concerned, then things must be done in a routine manner which will then ensure consistency.
If the resolution is say a closer walk with God by the end of the year for example, then the plan may be to sleep early enough and be able to wake up at say 5:00 am and pray and meditate on the Word of God.
This must be done every day, that is, you should have the discipline to make this routine behaviour which some people refer to as habit and that is what would ensure the realisation of your objective by the end of the year.
The question of how did you arrive at your new year’s resolution becomes very important. It brings in the God factor, which for me as a believer is very important because if you are say an Entrepreneur, then innovate ideas are what you need and according to Deuteronomy 8:18, innovative ideas to get wealth comes from God.
I believe that to be able to achieve our new year’s resolutions, we must approach them with a project management mindset. We should break the year into periods, either quarterly or monthly and evaluate our performance.
The end of the periods we have chosen should mark the achievement of certain goals or key milestones. This will reveal to us whether we are on track, whether we need to double up or there is the need to adjust certain things.
This year start looking at potential hindrances to the achievement of your resolutions. Check how much time you spend on social media for fun, like following the Akosua Serwaa and Odo Broni story and not for learning something useful that can add value to your life.
On a personal level, I have started cutting the time spent on listening to news and debates on various media platforms and using the time to polish my German and French as one of my resolutions.
Yours may be the time you spend on the phone chatting with friends, so please watch it and adjust especially as a child of God, so you too can have a testimony to share on December 31, 2026, to the glory of God. God bless.
NB: ‘KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT’
By Laud Kissi-Mensah
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