Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027066 (myoclonus)
 4,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Encephalitis lethargica (von Economo's encephalitis), pandemic from 1917 to 1926, opened a window on the study of behavioral consequences of infection-induced subcortical disorder. Widely varying acute manifestations included extrapyramidal disorders, myoclonus, eye movement disorders, paralyses, delirium, mood changes, inverted diurnal rhythms, and catatonia. Major pathological changes involved the substantia nigra, globus pallidus, and hypothalamus. A symptom-free recovery period was often followed by postencephalitic disturbances, typically parkinsonism in adults and conduct disorder in children. Occurrence of depression, mania, obsessive-compulsive disorder, and hyperactivity in post-encephalitic patients anticipated current concepts of the role of the basal ganglia in mood, personality, and obsessional syndromes. Observations of deferred onset and "tardy" hyperkinesias presaged current theories of the pathophysiology of tardive dyskinesia.
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PMID:Encephalitis lethargica: lessons for contemporary neuropsychiatry. 758 Feb 5

A 40-year-old female with a lumbar drain was admitted to the neurosurgery service with a bacterial meningitis. During the course of her treatment with multiple central nervous system (CNS) active medications, the patient became disoriented and agitated with visual hallucinations and generalized myoclonus. A psychiatric consultation was requested. The case is presented and discussed within the context of the importance of understanding etiological mechanisms in treating and reversing delirium. The fluoroquinolone agent ciprofloxacin was considered to be the primary etiology of the patient's delirium. This class of medication as a cause of altered mental status is discussed.
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PMID:The role of ciprofloxacin in a patient with delirium due to multiple etiologies. 773 96

Bismuth subsalicylate preparations are over-the-counter products for gastrointestinal complaints. Bismuth toxicity causes delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks or months, when bismuth intake is stopped. We report a 54-year-old man with a 6-week history of progressive confusion and memory difficulty and a 2-3-week history of involuntary movements and gait impairment. His encephalopathy was further characterized by marked multifocal myoclonic jerks, coarse postural tremors, postural instability, and gait ataxia. He gradually improved. Extensive toxic, metabolic, and infectious workup demonstrated bismuth toxicity. Spinal tap and brain magnetic resonance scan were normal. Electroencephalography showed bihemispheric slowing. As his encephalopathy cleared, he reported using bismuth subsalicylate long term (daily intake of 8 oz). Bismuth levels 5 weeks after cessation of bismuth were elevated and normalized after 12 weeks. He followed a typical course for bismuth toxicity with subacute progressive encephalopathy and gradual recovery. Creutzfeldt-Jakob was strongly considered due to his rapidly progressive encephalopathy, multifocal myoclonus, and ataxia. Due to its rarity, bismuth toxicity is often overlooked. We hope this presentation will increase recognition of bismuth toxicity. We believe more detailed labeling of bismuth products is needed to avoid similar toxicity from this readily available product.
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PMID:Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus. 775 66

In advanced cancer patients close to death, delirium, multifocal myoclonus, and restlessness may occur. Multi-organ failure and related metabolic changes are mostly responsible for these symptoms. A pharmacologic approach to manage the delirium is necessary in the majority of cases. Benzodiazepines, neuroleptics, and barbiturates are the most common drugs used. In the case reported, propofol administered at very low doses provided good control of neuropsychiatric symptoms. After a loading dose of 20 mg, an infusion of 50-70 mg per hr was started. The patient died peacefully after 8 hr of propofol infusion, without requiring opioids. Propofol seems to be a promising drug in treating the terminal agitated state that can be associated with the dying process.
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PMID:Propofol in terminal care. 859 25

In a retrospective study of 15.326 EEGs performed from 1983 to 1992 in a psychiatric institute, 83 EEGs (62 patients-13 men and 49 women ranging in age from 59 to 90 years, with a mean age of 74 years) had triphasic waves (TWs). All 62 patients were awake, though they were often confused. Most (n = 56) had dementia, usually severe; 15 also had delirium. There were six nondemented patients (age range, 59-79 years, with a mean age of 67 years). Infrequent etiologies included neuroleptic malignant syndrome (n = 1) and hepatic encephalopathy (n = 1); in four, the cause was uncertain, although all were receiving lithium. EEG features analyzed included frequency of background rhythms, distribution of the TWs, periodicity, and epileptiform abnormalities. Background rhythms were slow in all but seven patients (mean, 6.2 +/- 1.7 [SD] Hz). TWs were maximal posteriorly in 47 patients and anteriorly in six and were diffuse in nine. Neuroimaging studies showed prominent posterior abnormalities in only one case. Periodicity was prominent in four patients; in two the TWs were maximal anteriorly. Interictal epileptiform activity was present in six, a history of seizures in eight, and myoclonus in four. TWs are uncommon in a psychiatric population; they occur primarily in elderly, severely demented patients. They are usually associated with background slowing, are often maximal posteriorly, and occasionally are periodic.
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PMID:Triphasic waves in a psychiatric population: a retrospective study. 885 94

Fatal familial insomnia (FFI), or familial selective thalamic degeneration with a mutation at codon 178 of the prion protein (PrP) gene, is a rapidly progressive autosomal dominant disease characterized by progressive insomnia, dysautonomia, and myoclonus. We report here the clinical and postmortem findings as well as genomic analysis in a first non-Western case with FFI. This patient also clinically had cognitive impairments such as memory disturbance, delirium, and hallucinations, along with insomnia, dysautonomia, and myoclonus. This case implies a worldwide distribution of FFI and also highlights the need for more aggressive clinical application of genomic analysis of the PrP gene and polysomnographic study in patients with insomnia and cognitive impairments.
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PMID:Fatal familial insomnia with a mutation at codon 178 of the prion protein gene: first report from Japan. 890 48

Terminal restlessness is a variant of delirium observed in some patients in their last days of life. Readily reversible causes of restlessness should be identified and treated. Benzodiazepines give effective palliation of this condition, and, unlike haloperidol and the phenothiazines, do not exacerbate the existing tendency to myoclonus and convulsions.
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PMID:Palliative care: an update on "terminal restlessness". 900 13

Pain occurs in more than 80% of cancer patients before death. Because of the increase in the frequency of cancer deaths worldwide, it is imperative to address cancer pain as a public health problem. Until recently, educational efforts were focused on treatment issues rather than adequate assessment. The approach to pain intensity as a multidimensional construct has helped in focusing treatments and identifying prognostic factors. Valid tools have been developed that allow multidisciplinary assessment of these prognostic factors and their complex interrelationship with the analgesic response. As a result of increased opioid exposure, patients are currently developing newer toxicities, mostly central excitability including delirium, myoclonus, grand mal seizures, and hyperalgesia. The observation that more than 80% of patients will require alternate routes for opioid delivery before death led to the development of a number of novel and effective alternate routes for delivery. Finally, in recent years it has become evident that some specific pain syndromes need to be addressed using specific assessment and management techniques. Incidental pain, somatization, neuropathic pain, and cancer pain in patients with alcoholism and drug addiction are some of these syndromes.
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PMID:Cancer pain management. 906 Oct 98

A case of severe opioid toxicity is described in a 52-year-old cancer patient. The patient presented with classical clinical features of central hyperexcitability associated with opioid toxicity: delirium, myoclonus, hallucinations, hyperalgesia, and a possible seizure. This patient had a background of severe psychosocial distress and somatization in addition to a history of benzodiazepine dependence and alcohol abuse. The occurrence of opioid toxicity in this patient highlights the risks of a unidimensional approach to cancer pain, which ignores the non-organic components of pain, such as psychosocial distress, which will not respond to escalating doses of opioid medication.
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PMID:Severe opioid toxicity and somatization of psychosocial distress in a cancer patient with a background of chemical dependence. 920 57

We present the case of a 35-year-old woman who developed serotonin syndrome after receiving a single dose of the cyclic antidepressant imipramine (Tofranil). She was already being treated for depression with paroxetine (Paxil), a selective serotonin reuptake inhibitor. Two hours after receiving imipramine, the patient developed tachycardia, delirium, bizarre movements, and myoclonus, all classic findings of serotonin syndrome. Her antidepressants were discontinued and she was treated with intravenous fluids, sedation, and a short course of cyproheptadine, a serotonin receptor antagonist. All symptoms resolved completely within 24 hours. In this case report, we review the drug interactions that can precipitate serotonin syndrome, and give recommendations for the diagnosis and treatment of this potentially fatal disorder.
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PMID:Serotonin syndrome: case report and review of the literature. 941 60


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