Clinical Chemistry
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Clinical Chemistry 55: 126-133, 2009. First published November 21, 2008; 10.1373/clinchem.2008.110858
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(Clinical Chemistry. 2009;55:126-133.)
© 2009 American Association for Clinical Chemistry, Inc.

Drug Monitoring and Toxicology

Clinical Utility of an LC-MS/MS Seizure Panel for Common Drugs Involved in Drug-Induced Seizures

Julia C. Drees1, Judy A. Stone1,2, Kent R. Olson3,4, Kathryn H. Meier3,4, Alan M. Gelb5 and Alan H. B. Wu1,2,a

1 Department of Laboratory Medicine, University of California–San Francisco, San Francisco, CA; 2 Clinical Laboratory, San Francisco General Hospital, San Francisco, CA; 3 Clinical Pharmacy, University of California–San Francisco, San Francisco, CA; 4 California Poison Control System, San Francisco Division, San Francisco, CA; 5 Emergency Medicine, University of California–San Francisco, San Francisco, CA.

aAddress correspondence to this author at: 2M Clinical Laboratory, 1001 Potrero Ave., San Francisco, CA 94110. Fax 415-206-3045; e-mail wualan{at}labmed2.ucsf.edu.

Background: Approximately 6% of new-onset seizures are drug-related, but there is currently no reliable way to determine if a seizure is drug-induced. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) is a powerful tool that allows simultaneous detection of numerous analytes of diverse chemical nature in patient samples. This allows a single analysis to incorporate many compounds relevant to a particular clinical presentation, such as suspected drug-induced seizures. We investigated whether results from a seizure panel using LC-MS/MS could affect patient care.

Methods: We developed a semiquantitative LC-MS/MS assay to detect 12 chemically diverse drugs implicated in drug-related seizures. We collected leftover serum and plasma samples from patients who had seized, performed solid-phase extraction, and analyzed the samples using a hybrid triple quadrupole/linear ion trap mass spectrometer. After assembling a team of medical and toxicology experts, we developed and used a scoring system to determine whether the results of the seizure panel would have affected patient treatment in each case where a drug was detected.

Results: In an analysis of 157 samples from patients who seized, 17 (11%) were found to be positive for a drug on the seizure panel. The team of experts determined that the test results probably or definitely would have affected treatment in 7 (41%) of these cases.

Conclusions: A test that detects the presence of drugs implicated in drug-induced seizures can help physicians determine if an unexplained seizure is drug-related and thus potentially better direct patient care. Additionally, LC-MS/MS is an effective tool for answering clinically driven questions.






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Copyright © 2009 by the American Association for Clinical Chemistry.