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Abstract Details

Pediatric Phencyclidine (PCP) Intoxication: First Reported Human MRI and EEG Findings
Epilepsy/Clinical Neurophysiology (EEG)
Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)
142
Current understanding of MRI and EEG findings associated with phencyclidine (PCP) intoxication is based solely on in vitro pharmacology and animal models. This case report documents the clinical effects, and MRI and EEG findings of PCP intoxication in a pediatric patient.
Not Applicable
Not Applicable
A 12-month old, ex-full-term boy was found unresponsive by his mother and was brought to the emergency department (ED). He regained consciousness after midazolam administration. Initial labs identified PCP on urine toxicology (confirmed on history), hypoglycemia and elevated creatine kinase. He was hemodynamically stable and did not require oxygen supplementation. The initial video EEG showed multifocal epileptiform discharges during sleep with rare to occasional clusters of fronto-centrally predominant spike and slow wave discharges. Frontally predominant rhythmic delta (similar in appearance to FIRDA but prolonged) was observed with sleep into awake states, eventually resolving with sustained wakefulness. Despite initiation of levetiracetam, status epilepticus occurred on day 2 of presentation requiring lorazepam and phenobarbital rescues. Standing phenobarbital was added. Status epilepticus recurred on day 4, prompting a third standing antiepileptic, lacosamide. Seizures were independently multifocal with bilateral onset and clear fronto-centro-temporal predominance. A brain MRI with and without contrast on day 4 showed reduced diffusivity and confluent T2 hyperintensity throughout the subcortical white matter. A repeat MRI with and without contrast on day 15 was notable for slight cerebral volume loss, persistence of juxtacortical T2 hyperintensity, and near resolution of white matter diffusion restriction.
This is the first human case report to describe radiologic and electrographic findings in PCP intoxication. The patient’s EEG and late MRI findings are analogous to animal models of PCP intoxication, including high voltage frontally predominant delta waves, and global volume loss. Early diffusion restriction and T2 hyperintensity in white matter seen in our patient are unique findings not previously described.
Authors/Disclosures
Rebecca Stainman, MD (Nemour's Children's Health)
PRESENTER 		Dr. Stainman has nothing to disclose.
Aaron L. Nelson, MD, FÂ鶹´«Ã½Ó³»­ (NYU Langone Health) Dr. Nelson has nothing to disclose.
Heather Lau, MD (Ultragenyx) Dr. Lau has received personal compensation for serving as an employee of Ultragenyx. Dr. Lau has or had stock in Ultragenyx.