Nongenetic Cause of Epileptic Seizures in 2 Otherwise Healthy Chinese Families

Abstract

Tetramine, a banned rodenticide, is repeatedly reported to induce epileptic seizures in healthy people. Because both doctors and patients are often not aware of earlier tetramine contact, the occurrence of seizures is easily misdiagnosed as primary epilepsy. In this study, 8 cases in 2 families with generalized tonic-clonic seizures, most probably induced by tetramine, are presented. The clinical manifestation, electroencephalogram characteristics, and treatment measures of tetramine poisoning are summarized. There is the possibility of tetramine toxicity as a cause of epidemic epileptic seizures.

Post-exposure administration of diazepam combined with soluble epoxide hydrolase inhibition stops seizures and modulates neuroinflammation in a murine model of acute TETS intoxication

“…However, this high dose of diazepam did not stop electrographic seizures, and the animals died several hours after treatment (Shakarjian et al, 2012). These observations are consistent with case reports indicating that benzodiazepine therapy is not always efficacious in treating humans poisoned with TETS (Lu et al , 2008; Poon et al , 2005). Collectively, these data suggest that benzodiazepines alone are insufficient to protect against acute TETS poisoning.…”

Quantitation of tetramethylene disulfotetramine in human urine using isotope dilution gas chromatography mass spectrometry (GC/MS and GC/MS/MS)

“…Lu et al divided these exposure levels into three ranges [7]: mild poisoning (<50 ng/mL plasma), moderate poisoning (50-100 ng/mL plasma) and severe poisonings (>100 ng/mL plasma). Seizures were associated with moderate to severe poisoning [7]. The ratio between urine and plasma (urine/plasma) tetramine concentrations was reported to be 1.299 ± 0.388 [8].…”

“…Chau et al quoted toxic (2-369 ng/mL plasma) and lethal concentrations of tetramine (640-5490 ng/mL plasma) [4]. Lu et al divided these exposure levels into three ranges [7]: mild poisoning (<50 ng/mL plasma), moderate poisoning (50-100 ng/mL plasma) and severe poisonings (>100 ng/mL plasma). Seizures were associated with moderate to severe poisoning [7].…”

Behavioral intoxication following voluntary oral ingestion of tetramethylenedisulfotetramine: Dose-dependent onset, severity, survival, and recovery

“…The acute toxicity of TETS antagonism of the GABA system results from an over-excitement of central nervous system neurons. The disruption of the central nervous system caused by acute TETS poisoning leads to severe and widespread neurological and physical symptoms including convulsions, arrhythmias, hematological changes, coma, respiratory failure, refractory status epilepticus, and death [8, 10, 21]. Sub-lethal or chronic doses of TETS can lead to long-term multiple organ failure and permanent neurological impairment [10, 22].…”