Seizures associated with single substance exposures in pediatric patients: a 15-year retrospective study.

Introduction: This study aims to evaluate the trends, demographics, outcomes, and substances associated with single-substance exposures associated with in seizures in pediatric patients over 15 years.

Methods: This retrospective study of the National Poison Data System^® was conducted from 2009 to 2023, including pediatric patients (<20 years) who experienced seizures as a clinical effect associated with single-substance exposures. Cases with single seizures, multi/discrete seizures, or status epilepticus were included. Trends in annual frequency, seizure rates (per 100,000 exposures), and substances associated with seizures were examined.

Results: Thirty thousand nine hundred and eighty-five patients with single-substance exposures associated with seizures were identified, including 1,712 cases of status epilepticus. Reports to poison centers saw an increase in cases with seizures from 1,418 in 2009 to 2,749 in 2023. The seizure rate increased from 88 to 237 per 100,000 exposures. Patients aged 13-19 years accounted for the majority of cases (66.9%), followed by aged 0-5 years (24.0%) and 6-12 years (9.1%). Diphenhydramine and bupropion were the leading contributors, with diphenhydramine-related seizures increasing from 85 in 2009 to 404 in 2023 and bupropion cases rising from 162 in 2013 to 431 in 2023. Moderate and major effects were reported in 41.9% and 35.8% of cases, respectively, with nearly half (47.8%) requiring admission to critical care units.

Discussion: The current study shows an increase in substance-related pediatric seizures, particularly among adolescents and females. The significant need for critical care in nearly half of these cases shows the severity and potential long-term impact of these exposures.

Conclusions: Pediatric seizures associated with single-substance exposures are on the rise, driven primarily by diphenhydramine and bupropion. This trend highlights the need for targeted prevention strategies to reduce the burden of toxic exposures and safeguard the well-being of pediatric populations.