ABSTRACT
The patient was a 31-year-old woman who was vacationing in Arizona. After a long day of white-water rafting on the Colorado River in the Grand Canyon, she developed her first-ever seizures. They were described by a paramedic that witnessed them as being generalized tonic-clonic events that were associated with aspiration. She was taken to the closest hospital and treated with phenytoin and phenobarbital. After an initial improvement, she developed status epilepticus and was transferred to my facility. She was treated with pentobarbital for her status epilepticus and her seizures were controlled, but attempts to decrease the barbiturates caused further partial seizures with secondary generalization characterized by focal motor activity as well as generalized convulsive activity. Attempts to use both carbamazepine and valproate were not successful, owing to a marked increase in hepatic enzymes.
