Myoglobinuria, Malignant Hyperthermia, Neuroleptic Malignant Syndrome and Serotonin Syndrome

Bertorini, Tulio E.

doi:10.1016/s0733-8619(05)70338-8

Cited by 53 publications

(18 citation statements)

References 165 publications

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“…The mortality rates of NMS have been reported in a broad range of 4-20%. 19 Given the seriousness of the condition, we chose to administer ECT instead of further pharmacological trials in attempt to get a response as quick as possible. After the administration of ECT cure, we noted a clear reduction in the symptoms of NMS and those of IPD.…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Drug-Induced Psychiatric States and Neuroleptic Malignant Syndrome

Özer¹,

Meral²,

Aydın³

et al. 2005

The Journal of ECT

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In the late-stage idiopathic Parkinson's disease (IDP), comorbid conditions such as depression and drug-induced psychosis may be observed. A patient with Parkinson disease, major depression, and paranoid psychosis who developed neuroleptic malignant syndrome (NMS) as the result of the sudden termination of high-dose (1200 mg/d) levodopa treatment is presented in this report. Because the patient did not respond to other treatment modalities, electroconvulsive therapy (ECT) was applied, and a rapid improvement was observed both in the patient's NMS and also in Parkinson's and psychiatric symptoms, with no additional side effects other than transient post-ictal confusions. The application of ECT allowed the patient to remain stable for a 5-year period with a quite low dose of levodopa (300 mg/d). Later, the patient had two episodes of depressive and psychotic symptoms, which were again successfully treated with the ECT. We suggest that ECT might be an effective and life-saving therapy in patients with severe, drug-resistant NMS.

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Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Drug-Induced Psychiatric States and Neuroleptic Malignant Syndrome

Özer¹,

Meral²,

Aydın³

et al. 2005

The Journal of ECT

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“…17 18 These drugs have antiserotoninergic eVects in addition and, as serotonin normally inhibits dopamine activity or blocks its release, a combination of eVects may lead to the fall in dopamine activity. 18 Neuroleptics have also been shown to inhibit the mitochondrial complex 1 enzyme, so that there may be a direct eVect on muscle as well. 19 Ecstasy is a ring substituted methylamphetamine which aVects serotoninergic pathways, 20 while LSD has a high aYnity for serotonin receptors.…”

Section: Discussionmentioning

confidence: 99%

Muscle changes in the neuroleptic malignant syndrome

Behan

Madigan²,

Clark³

et al. 2000

J Clin Pathol

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Aims-To characterise the skeletal muscle changes in the neuroleptic malignant syndrome (NMS). Methods-Detailed light and ultrastructural examination was carried out on skeletal muscle from three cases of NMS, two associated with recreational drugs (3,4-methlenedioxymethylamphetamine (MDMA, Ecstasy) and lysergic acid diethylamide (LSD)) and one with antipsychotic drugs (fluoxetine (Prozac) and remoxipride hydrochloride monohydrate (Roxiam)). Results-The muscles were grossly swollen and oedematous in all cases, in one with such severe local involvement that the diagnosis of sarcoma was considered. On microscopy, there was conspicuous oedema. In some fascicles less than 10% of fibres were aVected whereas in others more than 50% were pale and enlarged. There was a spectrum of changes: tiny to large vacuoles replaced most of the sarcoplasm and were associated with necrosis. A striking feature in some fibres was the presence of contraction bands separating segments of oedematous myofibrils. Severe endomysial oedema was also detectable. There was a scanty mononuclear infiltrate but no evidence of regeneration. Conclusions-The muscle changes associated with NMS are characteristic and may be helpful in diVerential diagnosis. (J Clin Pathol 2000;53:223-227)

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“…De cerca de 4578 pacientes com doença de Parkinson, tratados com selegiline e medicação antidepressiva, 0,5% experimentaram sintomas consistentes com a ST 1 . Assim como a síndrome neuroléptica maligna e hipertemia maligna, a ST pode causar mioglobinúria 12 . Tratando de exames complementares, há somente um estudo: EEG apresentando ondas trifásicas 13 .…”

Section: Discussionunclassified

Síndrome serotoninérgica associada ao uso de paroxetina: relato de caso

Cavallazzi

Grezesiuk

1999

Arq. Neuro-Psiquiatr.

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RESUMO-Relatamos um caso de síndrome serotoninérgica pelo uso de inibidor da recaptação da serotonina, a paroxetina. Tal síndrome por esta droga, sem combinações, ainda não tinha sido descrita na literatura.PALAVRAS-CHAVE: síndrome serotoninérgica, paroxetina, mioclonia.Serotonin syndrome associated to the use of paroxetine: case report ABSTRACT-We report on a case of serotonin syndrome associated to the use of the paroxetine, a serotonin reuptake inhibitor drug. Serotonin syndrome related to this drug not combined with other drugs had not yet been described in literature.KEY-WORDS: serotonin syndrome, paroxetine, myoclonus.O uso de antidepressivos do tipo inibidor da recaptação da serotonina tem aumentado nos últimos anos em neurologia e psiquiatria. Como são drogas de introdução recente, pouco se sabe de seus efeitos secundários precoces e tardios. Relatamos um efeito colateral imediato dessas drogas, a síndrome serotoninérgica (ST). RELATO DO CASOMRA, 19 anos, sexo feminino, procurou auxílio médico com sintomas compatíveis com cefaléia tipo tensão episódica e quadro depressivo, com duração de aproximadamente um ano. O exame neurológico era normal. A tomografia computadorizada de crânio, foi normal. Iniciou-se o uso de paroxetina (Aropax) na dose diária de 10 mg , reajustada para 20 mg, 5 dias após o início do tratamento. A partir deste dia, a paciente apresentou quadro abrupto de sudorese fria, hipertemia (38ºC), hipotensão arterial, diaforese, palidez, sensações parestésicas pelo corpo, agitação psicomotora. Este quadro se acompanhava de contrações musculares mioclônicas abruptas e generalizadas nos membros superiores e inferiores, axiais e da face, com predomínio do hemicorpo direito. A paciente permaneceu internada por 48 horas, tendo sido suspensa a paroxetina e iniciado o uso de diazepan, 10 mg diárias, com melhoria das mioclonias generalizadas. Após três dias a paciente foi avaliada por nós e observamos persistência de episódios de mioclonias focais na hemiface direita e por vezes no membro inferior direito, levando-a a cair. A paciente relatava não estar fazendo uso de alimentos contendo triptofano. Os episódios de mioclonias chegavam a durar 10 minutos. Administramos clonazepan (Rivotril), 0, 75 mg por dia, com melhora gradual dos episódios mioclônicos ao longo de 45 dias seguintes. Um eletrencefalograma (EEG) realizado neste período foi normal.Residência de Neurologia do Hospital Governador Celso Ramos, Florianópolis, SC: *Preceptor; **Residente. Aceite: 25-junho-1999.Dr. Luís Otávio Cavallazzi -Rua Barão de Batovi 546 -88015-340 Florianópolis SC -Brasil.

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Myoglobinuria, Malignant Hyperthermia, Neuroleptic Malignant Syndrome and Serotonin Syndrome

Cited by 53 publications

References 165 publications

Electroconvulsive Therapy in Drug-Induced Psychiatric States and Neuroleptic Malignant Syndrome

Electroconvulsive Therapy in Drug-Induced Psychiatric States and Neuroleptic Malignant Syndrome

Muscle changes in the neuroleptic malignant syndrome

Síndrome serotoninérgica associada ao uso de paroxetina: relato de caso

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