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

Cappuccio, Gerarda; Brunetti‐Pierri, Nicola; Terrone, Gaetano; Romano, Alfonso; Andria, Generoso; Giudice, Ennio Del

doi:10.1007/8904_2012_188

Cited by 3 publications

(2 citation statements)

References 22 publications

(27 reference statements)

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“…Another important aspect of the disease is pain, a symptom sometimes reported in the literature. 9,10 It may be related to spasticity, constipation, or a variety of other factors. An important finding from this survey was that pain, sensitivity to touch, and irritability can be experienced even when a patient is quadriplegic or unable to communicate.…”

Section: Discussionmentioning

confidence: 99%

Metachromatic Leukodystrophy

et al. 2016

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Metachromatic leukodystrophy is accompanied by severe motor and cognitive dysfunction. This is the first survey of metachromatic leukodystrophy caregiver perspectives to identify relevant clinical/quality-of-life outcomes for patients/caregivers. Interviews and 1 focus group were conducted with 30 caregivers representing 23 patients. Caregivers were asked about their experiences, including diagnostic process, signs/symptoms, symptoms affecting caregivers' and patients' lives, and treatment priorities. Caregivers reported loss of physical autonomy, weight loss, limited social relationships, frequent crying, and challenging sibling relationships. Most troublesome symptoms were immobility (9/30) and respiratory difficulties (6/30). Health care visits were frequent: 8/22 patients had experienced ≥11 hospitalizations since diagnosis, and 14/22 caregivers reported that these lasted ≥4 days. Caregivers also experienced work problems, feelings of fear/sadness, and loss of social relationships. Caregivers/physicians consider a therapy that could improve decline in mobility, pain, cognitive ability, communication, or food intake as conferring the greatest benefit. In conclusion, a so-far-unreported physical/economic burden in these families is presented.

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Section: Discussionmentioning

confidence: 99%

Metachromatic Leukodystrophy

et al. 2016

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“…In patients with metachromatic leukodystrophy, AMT use at doses that are lower than the maintenance dose can lead to DTN onset. 57 Treatment of DTN involved withdrawal of AMT and complete recovery was achieved within days, even though most reports did not indicate the duration.…”

Section: Dystoniamentioning

confidence: 99%

The Link Between Amitriptyline and Movement Disorders: Clinical Profile and Outcome

Rissardo

Caprara

2020

Ann Acad Med Singap

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Introduction: Amitriptyline (AMT) is a tricyclic antidepressant. In this review, we evaluate the clinical and epidemiological profile, pathological mechanisms and management of AMT-associated movement disorders. Materials and Methods: A search for relevant reports in 6 databases was performed. Studies that reported patients developed only ataxia or tremor after AMT use were excluded. Results: A total of 48 reports on 200 cases were found. AMT-associated movement disorders included myoclonus (n = 26), dyskinesia (n = 11), dystonia (n = 8), stutter (n = 5), akathisia (n = 3) and restless legs syndrome (n = 1). For less well-defined cases, 99 patients had dyskinesia, 19 had psychomotor disturbances, 3 had myoclonus, 11 had dystonia, 12 had Parkinsonism and 1 each had akathisia and extrapyramidal symptoms. Mean and standard deviation (SD) and median ages were 45.40 years (SD 16.78) and 40 years (range 3.7–82 years), respectively. Over half were women (58.13%) and the most common indication was depression. Mean and median AMT doses were 126 mg (SD 128.76) and 75 mg (range 15–800 mg), respectively. In 68% of patients, onset of movement disorders was <1 month; time from AMT withdrawal to complete recovery was <1 month in 70% of cases. A weak negative linear correlation (r = −0.0904) was found between onset of movement disorders and AMT dose. AMT withdrawal was the most common treatment. Conclusion: Amitriptyline is associated with various movement disorders, particularly myoclonus, dystonia and dyskinesias. Stutters and restless legs syndrome are some of the less common associations. Ann Acad Med Singapore 2020;49:236–51 Key words: Akathisia, Drug-induced, Dyskinesia, Dystonia, Myoclonus

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Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Hauer

Houtrow

Hospice³

2017

Pediatrics

163

156

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Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, α-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.

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

Cited by 3 publications

References 22 publications

Metachromatic Leukodystrophy

Metachromatic Leukodystrophy

The Link Between Amitriptyline and Movement Disorders: Clinical Profile and Outcome

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

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