Acute dystonia due to amitriptyline.

Abstract

electric shock-like sensation into the shoulder and sometimes the upper arm. Non-steroidal anti-inflammatory medications produced no relief. She denied neck pain or weakness of the extremity. Cortisone injection into the area of pain gave only minimal relief.She had had papulofollicular thyroid carcinoma 20 years previously which required a modified radical neck dissection. There had been no recurrence. A left parotid tumour had been excised 10 years previously when she also received 5 600 rads to the left parotid.Cranial nerves were intact and there was an obvious large scar on the right retromandible area of the neck. There were no palpable nodes except for a small 1 cm tender nodule along the dorsolateral scapular border on the right. When compressed it reproduced severe pain. There were no motor signs. Sensory examination was normal, except for a small area on the top of the right shoulder. There was no loss of range of motion of the shoulder.A neuroma was suspected. Local injection with 1% xylocaine and epinephrine at the point of tenderness over the nodule produced total relief of pain. She had resection of the nodule with relief of pain and histology revealed a glomus tumour. Glomus tumour is rare, constituting 1-5% of all hand tumours occurring in the third to fifth decade of life.' Over 50% of glomus tumours are subungual. However, they occur on many body surfaces, but rarely include the trunk.3 4 They usually present with a triad of severe pain, tenderness, and cold sensitivity. Paroxysms of this triad are pathognomonic.3Glomus tumours are usually less than one centimeter in diameter and histological examination shows polyhedral cells, fibrostroma and small blood vessels. It may represent hyperplasia of a normal glomus body around arterioles.3 Prognosis is excellent and the relief spectacular, unless the tumour is incompletely removed.

Low-Dose Amitriptyline-Induced Acute Dystonia in a Patient with Metachromatic Leukodystrophy

“…Tremor, dysarthria, and akathisia due to amitriptyline have been observed. Only few cases of acute dystonia due to amitriptyline have been reported in adults, ascribed to overdose and/or long-term therapy, drug interactions (Ornadel et al 1999;Finder et al 1982;Lee 1988).…”

“…Side effects profile of amitriptyline includes sedation, dry mouth, impaired cardiovascular and central nervous system (CNS) function (Gore et al 2006); among extrapyramidal manifestations, acute dystonia has been reported in cases of long-term or overdose of amitriptyline treatment (Ornadel et al 1999;Finder et al 1982;Lee 1988). In the literature, two cases of pediatric amitriptyline poisoning are described (Baysal et al 2007;Doherty et al 2012).…”

Drug-induced dystonia

“…ОЛИД на фоне применения флуоксетина описаны в основном у пациентов, получавших сопутствующую терапию антипсихотиками [16]. На фоне применения трициклических антидепрессантов описаны ОЛИД у детей, получавших имипрамин для лечения ночного энуреза [17], и ТЛИД у молодых мужчин, получавших амитриптилин в дозе 50 мг для лечения депрессии [18,19]. Также описаны ОЛИД после приема селективного ингибитора обратного захвата серотонина и норадреналина венлафаксина [20,21].…”