Opsoclonus – Myoclonus syndrome induced by phenytoin intoxication

Verma, Rajesh; Kumar, Sanjeev; Biyani, Sumant; Singh, Anurag Kumar

doi:10.4103/0976-3147.145254

Cited by 7 publications

(8 citation statements)

References 4 publications

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“…The pathophysiological mechanisms of MCL are unclear, but probably, serotonin and cerebellar dysfunction play an important role[ 61 ]. Long-term use of PHT is associated with atrophy of cerebellar vermis, loss of Purkinje cells, and cerebellar dysfunction[ 25 ]. In addition, Baets et al .…”

Section: Discussionmentioning

confidence: 99%

“…The most widely chosen treatment was PHT discontinuation in 90.4% of the cases. Other therapeutic measures found were the continuation of the offending drug[ 24 ], dose augmentation[ 25 ], dose decrease[ 26 ], or even the addition of drugs such as carbamazepine, oxcarbazepine, phenobarbital, and valproate. Some authors described PHT rechallenges, and they demonstrated the reoccurrence of the MD[ 27 ].…”

Section: R Esultsmentioning

confidence: 99%

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Phenytoin-associated movement disorder: A literature review

Rissardo

Caprara

2022

Tzu Chi Med J

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Phenytoin (PHT) was first synthesized as a barbiturate derivative and was approved in 1953 by the Food and Drug Administration. This work aimed to review the pathophysiology, epidemiology, clinical presentation, and treatment of PHT-associated movement disorders (MDs). Studies were searched in relevant databases (ScienceDirect, Google Scholar, Excerpta Medica, Latin American and Caribbean Health Sciences Literature, Medline, and Scientific Electronic Library Online) and were selected by two reviewers irrespective of language between 1963 and 2021. Papers of PHT-induced ataxia alone or tremor were excluded. In total, 127 reports with 219 individuals who developed MDs associated with PHT were encountered. MDs found: 126 dyskinesias, 49 myoclonus, 19 dystonia, 14 parkinsonism, 6 tics, 3 stuttering, and 2 restless legs syndrome. The mean age was 35 years (standard deviation [SD]: 23.5) and the predominant sex was male (53.4%). The mean PHT dose when the MD took place was 370.4 mg (SD: 117.5). A serum PHT concentration was reported in 103 cases, ranging from 4 to 110 μg/mL (median: 27.7 μg/mL). No significant relationship was found between PHT dose and age or PHT level. The mean onset time of PHT-associated MD was 23.4 months (SD: 4.4). The mean recovery time after MD management was 3.7 weeks (SD: 1.1). Regarding management, the most common form was PHT withdrawal in 90.4%. 86.3% of the individuals recovered fully. PHT-induced MD was extensively reported in the literature. Only general terms were used in the majority of the reports. The mechanisms underlying the adverse events caused by PHT probably depend on the presence of predisposing factors.

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Section: Discussionmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Phenytoin-associated movement disorder: A literature review

Rissardo

Caprara

2022

Tzu Chi Med J

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“…Antiepileptics [32][33][34] Antiepileptic drugs are a diverse group of pharmacological agents used in the treatment of epilepsy. They are also being increasingly used in the treatment of various neuro-psychiatric and neurologic conditions, like bipolar disorder, borderline personality disorder, acting as mood stabilizers, and for the treatment of painful neuropathies.…”

Section: Chlordecone [17-20]mentioning

confidence: 99%

“…We describe three different cases (n = 3) of opsoclonus reported as an undesirable effect of an antiepileptic drug, probably phenytoin in 2 cases and possibly lamotrigine in the remaining case [32][33][34]. Due to the uncertain mechanism of action and specific role of each antiepileptic drug, these cases are going to be featured separately.…”

Section: Chlordecone [17-20]mentioning

confidence: 99%

Drug- and Toxin-Induced Opsoclonus – a Systematized Review, including a Case Report on Amantadine-Induced Opsoclonus in Multiple System Atrophy

Cannilla,

Messe,

Girardin

et al. 2024

Tremor and Other Hyperkinetic Movements

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Background: Opsoclonus is a rare disorder characterized by conjugate multidirectional, horizontal, vertical, and torsional saccadic oscillations, without intersaccadic interval, resulting from dysfunction within complex neuronal pathways in the brainstem and cerebellum. While most cases of opsoclonus are associated with autoimmune or paraneoplastic disorders, infectious agents, trauma, or remain idiopathic, opsoclonus can also be caused by medications affecting neurotransmission. This review was prompted by a case of opsoclonus occurring in a patient with Multiple System Atrophy, where amantadine, an NMDA-receptor antagonist, appeared to induce opsoclonus.Methods: Case report of a single patient and systematized review of toxic/drug-induced opsoclonus, selecting articles based on predefined criteria and assessing the quality of included studies. Results:The review included 30 articles encompassing 158 cases of toxic/drug-induced opsoclonus. 74% of cases were attributed to bark scorpion poisoning, followed by 9% of cases associated with chlordecone intoxication. The remaining cases were due to various toxics/drugs, highlighting the involvement of various neurotransmitters, including acetylcholine, glutamate, GABA, dopamine, glycine, and sodium channels, in the development of opsoclonus. Conclusion:Toxic/drug-induced opsoclonus is very rare. The diversity of toxics/drugs impacting different neurotransmitter systems makes it challenging to define a unifying mechanism, given the intricate neuronal pathways underlying eye movement physiology and opsoclonus pathophysiology.

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“…In the article published by Verma R, Kumar S, Biyani S, Singh A “Opsoclonus Myoclonus Syndrome induced by phenytoin intoxication” in Journal of Neurosciences in Rural Practice the association with phenytoin is described for the first time. [ 5 ]…”

mentioning

confidence: 99%

Commentary

Bîrluțiu

2014

Journal of Neurosciences in Rural Practice

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Opsoclonus – Myoclonus syndrome induced by phenytoin intoxication

Cited by 7 publications

References 4 publications

Phenytoin-associated movement disorder: A literature review

Phenytoin-associated movement disorder: A literature review

Drug- and Toxin-Induced Opsoclonus – a Systematized Review, including a Case Report on Amantadine-Induced Opsoclonus in Multiple System Atrophy

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