Lithium Intoxication Mimicking Clinical and Electrographic Features of Status Epilepticus: A Case Report and Review of the Literature

Abstract

A 58-year-old patient who was somnolent, distractible and confused is presented. She was previously treated with lithium, and a plasma level was mildly elevated at 1.7 mmol/l (normal 0.5–1.5 mmol/l). The EEG was suggestive of electrographic status epilepticus. Following treatment with i.v. lorazepam, neither mental status nor EEG abnormalities improved. She had a full recovery of mental function and markedly improved EEG findings following discontinuation of lithium. The EEG is an effective tool for diagnosing lithium neurotoxicity in patients with normal or mildly elevated lithium plasma levels. However, caution is needed before making an assumption of status epilepticus.