Serotonin syndrome associated with the use of anticonvulsants: Beyond a clinical case

Abstract

Introduction: Serotonergic syndrome (SS) is a potentially fatal clinical condition caused by serotonergic toxicity mainly associated with the use of drugs that intervene on serotonin metabolism and/or their inadvertent drug interactions. It has been classically characterized by the clinical trial of autonomic dysfunction, neuromuscular abnormalities and altered mental status, however SS establishes a clinical spectrum of findings ranging from mild symptoms and signs that can often be unnoticed, to severe complications and death.

Case presentation: A 72-year-old woman with a history of bipolar affective disorder and schizophrenia, presents a clinical picture of 48 hours of evolution of somnolence, fever and enteriform diarrheal episodes, additionally with physical examination findings of bilateral achilles clonus exhaustible and mild generalized rigidity; as an important fact in the 4 days prior to the debut of such symptoms, the dose of valproic acid (AVP) was increased. After medical management and discontinuation of AVP, she presented marked clinical improvement. A case of SS associated with the use of anti-crisis drugs is presented.

Discussion: The incidence of SS has increased in parallel with the increasing use of psychotropic drugs and the discovery of previously unexplained serotonergic properties. The diagnosis is established clinically, although different diagnostic criteria have been classically described, their diagnostic yield is a matter of controversy.

Conclusion: Adequate clinical response with discontinuation of valproic acid and medical management, together with the presence of diagnostic criteria and paraclinical reports, confirm the diagnosis of SS associated with this anti-crisis drug.