Abstract Details

Title Practice Alert: Generalized Tonic-Clonic Seizures Associated with Intra-arterial Administration of High Doses of Verapamil in Treatment of Cerebral Vasospasm

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-043

Objective To evaluate the association of generalized tonic-clonic seizures with intra-arterial verapamil infusion.

Background Seizures are not a recognized adverse event of intra-arterial administration of verapamil, a calcium channel blocker which decreases the calcium ion influx through L-type calcium channels. Verapamil is frequently used for treatment of cerebral vasospasm associated with subarachnoid hemorrhage.

Design/Methods A prospective registry was developed for patients undergoing intra-arterial administration of verapamil and identified those who had seizures. Variables collected for presentation include verapamil doses, artery treated, systemic blood pressure and intracranial pressure changes during the administration. We also attempted to identify if there was a correlation between dose of verapamil administered and the seizures.

Results Generalized tonic-clonic seizures were observed in 4 of 36 verapamil infusion treatments (median dose = 35mg, range = 10 - 70 mg). All the seizure episodes occurred after intra-arterial administration of verapamil (median dose = 50 mg, range = 45 - 70 mg). The median dose of verapamil infusion that resulted in seizures was higher when compared with those without seizures (50 mg versus 35 mg, p = 0.05). The average of mean arterial blood pressure was also found to be dropped at the end of high dose verapamil infusion when compared with the value of pre-infusion mean arterial pressure (81.8 ± 10.7 mmHg versus 100.3 ± 10.8 mmHg, p = 0.05). Seizures were only seen when doses of verapamil administered were greater than 40 mg. In two patients, intra-arterial nicardipine infusion was subsequently used for rescue (median dose = 20 mg, range = 15 - 28 mg) without any recurrence of seizures.

Conclusions Generalized tonic-clonic seizures can occur after intra-arterial administration of high doses of verapamil through the unclear mechanism. Changing to a different vasodilatory agent may be helpful in such situations.

Authors/Disclosures
PRESENTER	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Muhammad U. Jahngir, MD	No disclosure on file
Laura Qi, MD (University of Minnesota)	No disclosure on file
	No disclosure on file

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