PubMed · 2496333
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J W Sander, Y M Hart, J S Duncan, S D Shorvon. 1989. Zonisamide usage.. https://doi.org/10.1212/wnl.39.5.749
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OBJECTIVE: To report a case of seizures occurring during administration of high-dose intravenous morphine containing sodium bisulfite as a preservative. CASE SUMMARY: A 56-year-old woman hospitalized with multiple myeloma developed myoclonic and tonic-clonic seizures following administration of intravenous morphine with sodium bisulfite preservative at doses exceeding 400 mg/h. These seizures resolved when the morphine was discontinued, anticonvulsants were administered, and the drug therapy was changed to intravenous fentanyl without preservative. DISCUSSION: The factors potentially associated with this adverse reaction are discussed and the literature concerning the adverse central nervous system effects of opiates and sulfites is reviewed. CONCLUSIONS: High doses of intravenous morphine with sulfite preservative may be associated with seizure development. If patients require high doses of intravenous morphine, a preservative-free formulation should be used to avoid possible additive or synergistic toxicities.
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Epileptic syndromes are classified in order to supply the clinician with a useful terminology. A description of individual types of seizure is not relevant in practice since identical seizures occur in patients with very different outcomes. An epileptic syndrome is an epileptic disorder characterized by a cluster of signs and symptoms. It has therapeutic and prognostic implications. Our proposal for classification of epileptic syndromes is a compromise between scientific classification and practical arrangement.