Drug-Induced Seizures

Numerous drugs have been reported to be associated with the occurrence of seizures, although the strength of the association is variable and remains to be clarified in many cases. In determining the link between drug use and seizure occurrence, allowance must be made for the presence of potentially confounding factors. Premarketing studies and case reports may alert physicians to the possibility of drug-induced seizures, while postmarketing surveillance allows better quantification of the risk, as illustrated by the examples of clozapine, tramadol and mefloquine in this review. While various direct and indirect mechanisms may explain a drug-associated seizure, in many cases the finding is an empirical one without obvious explanation.In assessing patients with new-onset seizures, awareness of the growing use of complementary medicines and knowledge of their pharmacology is necessary. Management and prevention of drug-induced seizures centres on good clinical practice, physician and patient education, and postmarketing safety surveillance of currently implicated and newly available drugs.