Myoclonus and delirium associated with ciprofloxacin

Jayathissa, Sisira; Woolley, Michelle; Ganasegaram, Maneka; Holden, Joanne; Cu, Eunice

doi:10.1093/ageing/afq107

Cited by 11 publications

(14 citation statements)

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“…Myoclonus can be triggered or aggravated by a large number of different drugs used in intensive care including opioids, such as hydromorphone (Babul and Darke, 1992;Patel et al, 2006), morphine (Potter et al, 1989), and fentanyl (Stuerenburg et al, 2000); nonsteroidal anti-inflammatory drugs (Bandelot and Mihout, 1978); neuroleptics (Pedavally et al, 2014;Strachan and Benoff, 2006;Vural and Tezer, 2012); antiepileptic drugs in high doses, such as carbamazepine (Magaudda and Di Rosa, 2012), oxcarbazepine (Fanella et al, 2013), lamotrigin (Algahtani et al, 2014), topiramate (Miller et al, 2010), pregabalin and gabapentin (Ege et al, 2008;Healy et al, 2009;Hellwig and Amtage, 2008), phenytoin (Duarte et al, 1996), and valproic acid (Gardner et al, 2009); antidepressants (Caviness and Evidente, 2003;Evidente and Caviness, 1999;Praharaj et al, 2010); the amino acid precursor of dopamine -levodopa (Yoshida et al, 1993) and bromocriptine (Buchman et al, 1987); antibiotics such as imipenem (Frucht and Eidelberg, 1997), cefepime (Fugate et al, 2013), penicillin (Sackellares and Smith, 1979), gentamycin (Sarva and Panichpisal, 2012), ciprofloxacin (Jayathissa et al, 2010), and piperazine (Kompf and Neundorfer, 1974); antihistamines (Irioka et al, 2008); and chemotherapeutics (Denison and Alghzaly, 2006;Savica et al, 2011;Wyllie et al, 1997). Some anesthetics have also been associated with the emergence and aggravation of myoclonus including etomidate …”

Section: Symptomatic Myoclonus In the Icumentioning

confidence: 99%

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Myoclonus in the critically ill: Diagnosis, management, and clinical impact

Sutter

Ristic

Rüegg

et al. 2016

Clinical Neurophysiology

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Myoclonus is the second most common involuntary non-epileptic movement in intensive care units following tremor-like gestures. Although there are several types of myoclonus, they remain underappreciated, and their diagnostic and prognostic associations are largely ignored. This review discusses clinical, electrophysiological, neuroanatomical, and neuroimaging characteristics of different types of myoclonus in critically ill adults along with their prognostic impact and treatment options. Myoclonus is characterized by a sudden, brief, and sometimes repetitive muscle contraction of body parts, or a brief and sudden cessation of tonic muscle innervation followed by a rapid recovery of tonus. Myoclonus can resemble physiologic and other pathologic involuntary movements. Neurologic injuries, anesthetics, and muscle relaxants interfere with the typical appearance of myoclonus. Identifying "real myoclonus" and determining the neuroanatomical origin are important, as treatment responses depend on the involved neuroanatomical structures. The identification of the type of myoclonus, the involved neuroanatomical structures, and the associated illnesses is essential to direct treatment. In conclusion, the combined clinical, electrophysiological, and neuroradiological examination reliably uncovers the neuroanatomical sources and the pathophysiology of myoclonus. Recognizing cortical myoclonus is critical, as it is treatable and may progress to generalized convulsive seizures or status epilepticus.

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Section: Symptomatic Myoclonus In the Icumentioning

confidence: 99%

“…Diltiazem (Jeret, 2002) Propafenone (Chua et al, 1994) Antibiotic drugs Imipenem (Frucht and Eidelberg, 1997) Cefepime (Fugate et al, 2013) Penicillin (Sackellares and Smith, 1979) Gentamycin (Sarva and Panichpisal, 2012) Ciprofloxacin (Jayathissa et al, 2010) Piperazine (Kompf and Neundorfer, 1974) Antihistamines…”

Section: Cardiac Medicationmentioning

confidence: 99%

Myoclonus in the critically ill: Diagnosis, management, and clinical impact

Sutter

Ristic

Rüegg

et al. 2016

Clinical Neurophysiology

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“…4,5 Drug-induced delirium is a well-known entity with sedatives, narcotics, and anticholinergics. 6,7 Delirium related to antibiotics, mainly cephalosporins, macrolides, and other fluoroquinolones, [8][9][10] has been infrequently reported, but only a few cases of levofloxacin-induced delirium have been previously published. [11][12][13][14] We described another case of delirium associated with levofloxacin in a 55-year-old male patient who was hospitalized in our medical clinic for acute renal failure and pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Levofloxacin-Induced Delirium: Is It a Dangerous Drug in Patients with Renal Dysfunction?

et al. 2012

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The central nervous system (CNS) toxicity of fluoroquinolones is well known but usually occurs benign. In the literature, there are a few number of severe CNS toxicity cases related to fluoroquinolones. Levofloxacin is a third-generation fluorinated quinolone antibiotic, is the active levo stereoisomer of ofloxacin, and has one of the most favorable adverse reaction profiles. We describe a case of delirium associated with levofloxacin in a 55-year-old man who was hospitalized in our medical clinic for pneumonia.

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“…Myoclonus due to β-lactam antibiotics clinically varies from subtle peri-ocular twitching to generalized myoclonus [75]. Myoclonus due to quinolones can be generalized [21, 38] or multifocal [81]. It is hypothesized that β-lactam antibiotics selectively antagonize [75] and quinolones completely inhibit [71] gamma aminobutyric acid (GABA) receptors, decreasing their inhibitory activity at nerve terminals, thus inducing a hyperexcitable neuronal state of the central nervous system that triggers myoclonus.…”

Section: Resultsmentioning

confidence: 99%

The clinical heterogeneity of drug-induced myoclonus: an illustrated review

2016

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A wide variety of drugs can cause myoclonus. To illustrate this, we first discuss two personally observed cases, one presenting with generalized, but facial-predominant, myoclonus that was induced by amantadine; and the other presenting with propriospinal myoclonus triggered by an antibiotic. We then review the literature on drugs that may cause myoclonus, extracting the corresponding clinical phenotype and suggested underlying pathophysiology. The most frequently reported classes of drugs causing myoclonus include opiates, antidepressants, antipsychotics, and antibiotics. The distribution of myoclonus ranges from focal to generalized, even amongst patients using the same drug, which suggests various neuro-anatomical generators. Possible underlying pathophysiological alterations involve serotonin, dopamine, GABA, and glutamate-related processes at various levels of the neuraxis. The high number of cases of drug-induced myoclonus, together with their reported heterogeneous clinical characteristics, underscores the importance of considering drugs as a possible cause of myoclonus, regardless of its clinical characteristics.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-016-8357-z) contains supplementary material, which is available to authorized users.

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Myoclonus and delirium associated with ciprofloxacin

Cited by 11 publications

References 1 publication

Myoclonus in the critically ill: Diagnosis, management, and clinical impact

Myoclonus in the critically ill: Diagnosis, management, and clinical impact

Levofloxacin-Induced Delirium: Is It a Dangerous Drug in Patients with Renal Dysfunction?

The clinical heterogeneity of drug-induced myoclonus: an illustrated review

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