Paradoxical Reaction Following Administration of a Benzodiazepine

McKenzie, William; Rosenberg, Morton

doi:10.1016/j.joms.2010.06.176

Cited by 23 publications

(10 citation statements)

References 9 publications

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“…The postsynaptic effect, however, of all GAB drugs on GABA transmission is related to chloride levels in the target cells. Paradoxical behavioral disinhibition following benzodiazepines and barbiturates is a well‐known phenomenon, both in clinical and nonclinical populations . AEDs that are stated to have mood‐stabilizing effects include topiramate and valproate, both GAB AEDs.…”

Section: Discussionmentioning

confidence: 99%

“…Paradoxical behavioral disinhibition following benzodiazepines and barbiturates is a well-known phenomenon, both in clinical and nonclinical populations. 10,12,17,[22][23][24] AEDs that are stated to have moodstabilizing effects include topiramate and valproate, 6 both GAB AEDs. Interestingly, 12 of the behavioral disinhibition cases were reported after initiation of use of topiramate (n = 1) and valproate (n = 11).…”

Section: Discussionmentioning

confidence: 99%

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Behavioral disinhibition and antiepileptic treatment in childhood epilepsy: A retrospective cohort study

et al. 2017

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SummaryObjectiveTo test whether specific classes of antiepileptic drugs increase the risk for behavioral disinhibition, a frequent complication of treatment of childhood epilepsy.MethodsIn a sample of children with active epilepsy and antiepileptic drug (AED) treatment (n = 146, age 4–17 years), we performed a retrospective chart analysis of the occurrence of symptoms indicating reduced behavioral disinhibition following AED treatment. We used a risk‐set approach to analyze whether the presence or recent addition of AED categories defined by their mechanism of action were associated with enhanced risk for behavioral disinhibition symptoms.ResultsMean duration of follow‐up was 2,343 days (range 218–6,292, standard deviation [SD] 1,437). Episodes of behavioral disinhibition were reported in 51 (34.9%) children, with variable latencies between latest change and occurrence of behavioral disinhibition symptoms (mean 67 days, range 2–367). Current use of AEDs targeting gamma‐aminobutyric acid (GABA) (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.02–3.29, p = 0.04) and SV2A‐mediated neurotransmitter release (SV2A)‐mediated (2.0, 1.13–3.60, p = 0.02) neurotransmitter release was associated with increased risk for behavioral disinhibition. Restricting the analysis to the 90 days before behavioral disinhibition episode occurrence revealed that only addition of GABAergic AEDs (OR = 26.88, 95% CI = 6.71–107.76, p < 0.001) was associated with behavioral disinhibition. In contrast to our expectations, seizure control was reported to have improved parallel to most behavioral disinhibition episodes.SignificanceThis exploration of behavioral disinhibition in relation to antiepileptic drug treatment indicates that GABA potentiating drugs are specifically associated with behavioral problems during treatment of childhood epilepsy. Behavioral disinhibition episodes often occurred while seizure control improved, which may have reduced alertness for the consequences of AEDs on interictal symptoms. Our findings may be related to the increasing evidence for a role for excitatory actions of GABA in childhood epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Behavioral disinhibition and antiepileptic treatment in childhood epilepsy: A retrospective cohort study

et al. 2017

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“…In less than 1% of patients, paradoxical reactions to benzodiazepines may occur, characterised by increased talkativeness, emotional release, excitement and excessive movement. The exact mechanism of paradoxical reactions remains unclear (Gutierrez et al 2001;Robin and Trieger 2002;Mancuso et al 2004;McKenzie and Rosenberg 2010). Basu et al 2009;Rocha et al 2009).…”

Section: Benzodiazepine Derivativesmentioning

confidence: 99%

Toxicology of Specific Substances

Jones

Mußhoff

Kræmer

et al. 2014

Handbook of Forensic Medicine

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“…Es wirkt über eine Modulation am GABA(A)-Rezeptor [10]. Allerdings sind für Midazolam auch paradoxe Reaktionen im Sinne einer Agitation und Aggressivität anstelle der gewünschten Sedierung beschrieben [10,18]. Reminfentanil und Sufentanil sind synthetische Opioide.…”

Section: Narkosemedikamenteunclassified

Silexan und Narkose

Decker

Polarz

2011

Anaesthesist

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The increased use of phytotherapeutic drugs means that anesthetists are more often confronted with these drugs. In this case report possible problems which can occur are demonstrated exemplified by silexan. Silexan is a phytotherapeutic anxiolytic which is used in anxiety disorders. Because of its potential mechanism of action via the neurotransmitter gamma-aminobutyric acid (GABA) receptors interactions with narcotic drugs are possible. The case of an 18-year-old girl who underwent an operation under general anesthesia while taking silexan as long-term medication is presented. The desired depth of narcosis could only be reached by inhalative induction with sevoflurane after unsuccessful induction attempts using intravenous propofol and thiopental. Possible explanations for this route and inhalative induction as a possible alternative are discussed.

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Paradoxical Reaction Following Administration of a Benzodiazepine

Cited by 23 publications

References 9 publications

Behavioral disinhibition and antiepileptic treatment in childhood epilepsy: A retrospective cohort study

Behavioral disinhibition and antiepileptic treatment in childhood epilepsy: A retrospective cohort study

Toxicology of Specific Substances

Silexan und Narkose

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