A 65M TCC resident with a PMH of HIV (CD4 count 24, VL 12K), cerebral toxoplasmosis in 2012, seizure disorder on keppra 1000mg BID, and endstage dementia was BIBEMS from TCC at noon for status epilepticus x 1.5 hours.  He had not had his antiepileptic meds changed recently, and he had had his morning keppra dose.  His last seizure was 6 months ago.  What new medications other than AEDs could be contributing to this situation?

Many medications lower the seizure threshold, and it is very important to be aware of the major ones since many are prescribed or encountered in the ED.  These include: antibiotics (INH, flagyl, PCNs, cephalosporins, fluoroquinolones), antidepressants (tricyclics, SSRIs, buproprion), hormones (insulin, prednisone, estrogen), local anesthetics (lido, bupivicaine), narcotics (fentanyl), stimulants (amphetamines, cocaine, methylphenidate), and other medications (anticholinergics, antihistamines, lithium, and some oral hypoglycemics).

Our patient had been diagnosed with PNA several days before and had started levaquin.