Can Rhabdomyolysis (Rhabdo) cause seizures?

From the Guidelines

Rhabdomyolysis is a potential cause of seizures, particularly in cases where severe electrolyte imbalances or acute kidney injury occur. According to the study by Henneman et al 1, rhabdomyolysis was identified as a significant abnormality in patients presenting with seizures, highlighting the importance of considering this condition in the differential diagnosis. The study found that 2 patients who were judged to have needed admission but would have been discharged on the basis of ED evaluation developed rhabdomyolysis, emphasizing the need for careful evaluation and monitoring of patients with seizures.

Key points to consider in the evaluation and management of patients with seizures and potential rhabdomyolysis include:

• Severe electrolyte imbalances, such as low calcium, high potassium, or low sodium, can contribute to the development of seizures in patients with rhabdomyolysis
• Acute kidney injury resulting from rhabdomyolysis can lead to the buildup of toxins and contribute to neurological symptoms, including seizures
• Metabolic acidosis resulting from muscle breakdown can also contribute to neurological symptoms, including seizures
• Immediate medical attention is essential if someone with rhabdomyolysis experiences seizures, as this indicates a severe case requiring prompt treatment with IV fluids, electrolyte correction, and possibly dialysis if kidney function is severely compromised.

The primary focus of treatment should be addressing the underlying rhabdomyolysis while simultaneously managing any neurological complications that arise, as recommended by the American College of Emergency Physicians, American Academy of Neurology, American Association of Neurological Surgeons, American Society of Neuroradiology 1.

From the Research

Rhabdomyolysis and Seizures

• Rhabdomyolysis is a condition that can be caused by various factors, including seizures 2, 3, 4.
• Seizures are listed as a frequent cause of severe rhabdomyolysis, along with crush injuries, prolonged immobilization, severe infections, and drug toxicity 2.
• The clinical syndrome of rhabdomyolysis is caused by injury of skeletal muscles, leading to the release of various intracellular muscle constituents, which can result in severe electrolyte disorders and acute renal failure 2.
• Rhabdomyolysis can develop in any circumstances where energy demands in muscles exceed the available energy supplies, and seizures can be a contributing factor to this condition 3.

Relationship Between Rhabdomyolysis and Seizures

• Rhabdomyolysis is a rare potentially dangerous syndrome resulting from the dissolution of skeletal muscle fibers, and seizures are one of the possible causes of this condition 4.
• An isolated attack of rhabdomyolysis can have various causes, including seizures, trauma, hyperpyrexia, infections, electrolyte imbalances, and severe exertion 4.
• Recurrent episodes of rhabdomyolysis and/or a family history of rhabdomyolysis are more likely caused by an underlying genetic defect, but seizures can still be a contributing factor to the development of rhabdomyolysis 4.

Complications of Rhabdomyolysis

• Rhabdomyolysis can result in acute kidney injury (AKI) and electrolyte imbalances, which can lead to cardiac dysrhythmia and even death 5, 6.
• The diagnosis of rhabdomyolysis is confirmed by elevated creatine kinase levels, but additional testing is needed to evaluate for potential causes, electrolyte abnormalities, and AKI 5.
• Treatment of rhabdomyolysis is aimed at discontinuation of further skeletal muscle damage, prevention of acute renal failure, and rapid identification of potentially life-threatening complications 5.