Differentiating Encephalopathy From Seizure in Organophosphate Poisoning: Utility of a Benzodiazepine Trial and Risk Scoring

TL;DR

This paper discusses how to tell the difference between brain dysfunction and seizures in poisoning cases using a drug test and scoring system.

Contribution

The paper introduces a structured approach using a benzodiazepine trial and the 2HELPS2B risk score to differentiate encephalopathy from seizures in organophosphate poisoning.

Findings

A benzodiazepine trial led to electrographic resolution without clinical improvement, supporting a diagnosis of nonictal TME.

The 2HELPS2B risk score was 0, indicating a low risk of nonconvulsive status epilepticus.

This approach helped avoid unnecessary antiseizure medication in a case of organophosphate poisoning.

Abstract

Organophosphate poisoning can present with generalized periodic discharges (GPDs) on electroencephalography (EEG), posing a diagnostic challenge in differentiating toxic metabolic encephalopathy (TME) from nonconvulsive status epilepticus (NCSE). We report the case of a 76-year-old woman with organophosphate poisoning who presented with coma and 2.0 Hz triphasic GPDs. A diagnostic benzodiazepine trial resulted in electrographic resolution without clinical improvement, and the 2HELPS2B risk score was 0. These findings supported a diagnosis of nonictal TME, allowing for the avoidance of aggressive antiseizure medication. This case highlights the utility of a structured approach using a benzodiazepine trial and risk stratification scoring to guide management in ambiguous EEG patterns associated with organophosphate poisoning.

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