Movement Disorders Emergencies

2019 ◽  
Vol 39 (01) ◽  
pp. 125-136 ◽  
Author(s):  
Suraj Rajan ◽  
Bonnie Kaas ◽  
Emile Moukheiber
Keyword(s):  
Movement Disorders ◽  
Serotonin Syndrome ◽  
Clinical Presentation ◽  
Treatment Modalities ◽  
Drug Induced ◽  
Status Dystonicus ◽  
Life Threatening ◽  
At Risk Populations ◽  
Clinical Phenomenology ◽  
Malignant Catatonia

AbstractMany acute and potentially life-threatening medical conditions have hyperkinetic or hypokinetic movement disorders as their hallmark. Here we review the clinical phenomenology, and diagnostic principles of neuroleptic malignant syndrome, malignant catatonia, serotonin syndrome, Parkinsonism hyperpyrexia, acute parkinsonism, acute chorea-ballism, drug-induced dystonia, and status dystonicus. In the absence of definitive lab tests and imaging, only a high index of clinical suspicion, awareness of at-risk populations, and variations in clinical presentation can help with diagnosis. We also discuss the principles of management and rationale behind treatment modalities in the light of more recent evidence.

The management of bleeding in palliative care

2015 ◽  
Author(s):  
Jose Pereira ◽  
Jennifer Brodeur
Keyword(s):  
Palliative Care ◽  
Care Setting ◽  
Clinical Presentation ◽  
Advanced Disease ◽  
Case Reports ◽  
Treatment Modalities ◽  
Low Grade ◽  
Palliative Care Setting ◽  
Life Threatening ◽  
Number Of Treatment

Bleeding is one of the more distressing symptoms experienced by patients with advanced life-threatening illnesses. The prevalence and incidence of bleeding in these patients vary depending on the disease and the illness trajectory. The causes of bleeding in patients with advanced disease are varied and sometimes several aetiologies or aggravating factors occur simultaneously in any given patient. The clinical presentation may be visible, as in haemoptysis or hematemesis, or invisible, as in cerebral haemorrhaging, and volumes may vary, from low-grade oozing to massive and catastrophic haemorrhaging. Catastrophic, terminal haemorrhaging warrants special attention because of its dramatic clinical presentation and the profound distress it causes to patients, families, and caregivers. A number of treatment modalities are available and these can be divided into (a) general measures, (b) local measures, and (c) systemic measures. Unfortunately studies in the palliative care setting comparing various modalities and approaches are generally lacking and guidelines are largely based on case reports and expert opinion.

scholarly journals Successful Treatment of Antiepileptic Drug-Induced DRESS Syndrome with Pulse Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Celebi Kocaoglu ◽  
Ceyda Cilasun ◽  
Ece Selma Solak ◽  
Gulcan S. Kurtipek ◽  
Sukru Arslan
Keyword(s):  
Valproic Acid ◽  
Present Report ◽  
Treatment Modalities ◽  
Dress Syndrome ◽  
Internal Organs ◽  
Drug Induced ◽  
Pulse Methylprednisolone ◽  
Lymph Node Enlargement ◽  
Life Threatening ◽  
Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially life-threatening syndrome characterized by skin rash, fever, lymph node enlargement, and involvement of internal organs. It is most commonly induced by aromatic anticonvulsants and antibiotics. Nonaromatic anticonvulsants are rarely encountered as the causes of DRESS syndrome. In the present report, three discrete cases with DRESS syndrome developing due to three antiepileptic drugs, including valproic acid (nonaromatic), carbamazepine (aromatic), and lamotrigine (aromatic), and their treatment modalities were aimed to be discussed in light of the literature. To the best of our knowledge, our cases are the first children to be treated with pulse methylprednisolone in the literature.

scholarly journals Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

2019 ◽  
Vol 12 ◽  
pp. 117864691987392 ◽  
Author(s):  
William J Scotton ◽  
Lisa J Hill ◽  
Adrian C Williams ◽  
Nicholas M Barnes
Keyword(s):  
Serotonin Syndrome ◽  
Tryptophan Hydroxylase ◽  
Monoamine Oxidase Inhibitor ◽  
Receptor Activation ◽  
Clinical Findings ◽  
Oxidase Inhibitor ◽  
Health Concern ◽  
Drug Induced ◽  
Life Threatening ◽  
Serotonergic Drugs

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1A and 5-HT2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

Drug-Induced Serotonin Syndrome

2017 ◽  
Vol 37 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Dana Bartlett
Keyword(s):  
Monoamine Oxidase ◽  
Serotonin Receptor ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Serotonin Metabolism ◽  
Drug Induced ◽  
Confirmatory Tests ◽  
Life Threatening ◽  
Serotonin Receptor Agonists ◽  
Norepinephrine Reuptake

Serotonin syndrome is a potentially fatal condition caused by drugs that affect serotonin metabolism or act as serotonin receptor agonists. Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are the medications most commonly associated with serotonin syndrome. Serotonin syndrome can be mild and of short duration, but a prolonged course, life-threatening complications, and death are possible. Detection of serotonin syndrome is not difficult if the diagnostic criteria are understood and properly used, but the syndrome has no confirmatory tests and other drug-induced syndromes can, to a degree, mimic serotonin syndrome. The treatment is symptomatic and supportive. Antidotal therapies are available, but the evidence for their effectiveness is limited. If serotonin syndrome is promptly identified and aggressively treated, the patient should fully recover.

scholarly journals Movement disorders emergencies: a review

2012 ◽  
Vol 70 (6) ◽  
pp. 453-461 ◽  
Author(s):  
Renato P. Munhoz ◽  
Mariana Moscovich ◽  
Patrícia Dare Araujo ◽  
Hélio A. G. Teive
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Movement Disorders ◽  
Clinical Presentation ◽  
Voluntary Movements ◽  
Stiff Person Syndrome ◽  
Loss Of Control ◽  
Drug Reactions ◽  
Or Efficiency ◽  
Status Dystonicus

Movement disorders (MD) encompass acute and chronic diseases characterized by involuntary movements and/or loss of control or efficiency in voluntary movements. In this review, we covered situations in which the main manifestations are MDs that pose significant risks for acute morbidity and mortality. The authors examine literature data on the most relevant MD emergencies, including those related to Parkinson's disease, acute drug reactions (acute dystonia, neuroleptic malignant syndrome, serotonergic syndrome and malignant hyperthermia), acute exacerbation of chronic MD (status dystonicus), hemiballism and stiff-person syndrome, highlighting clinical presentation, demographics, diagnosis and management.

Drug-Induced Movement Disorders

2007 ◽  
Vol 20 (6) ◽  
pp. 415-429 ◽  
Author(s):  
Katherine L. Claxton ◽  
Jack J. Chen ◽  
David M. Swope
Keyword(s):  
Movement Disorders ◽  
Drug Exposure ◽  
Healthcare Professionals ◽  
Clinical Presentation ◽  
Disease Relapse ◽  
Drug Induced ◽  
Conventional Antipsychotics ◽  
Significant Burden ◽  
Treatment Plans

Drug-induced movement disorders (DIMDs) pose a significant burden to patients, often resulting in nonadherence, disease relapse, and decreased quality of life. Dopamine-receptor blocking agents such as conventional antipsychotics (eg, haloperidol and chlorpromazine) and antiemetics (eg, metoclopramide and prochlorperazine) are most commonly implicated. DIMDs can be categorized by the onset of symptoms: acute reactions occurring hours to days after exposure, subacute DIMDs appearing within weeks, and tardive occurring months to years after drug exposure. The DIMDs of akathisia, tardive dyskinesia, dystonia, and parkinsonism are reviewed. Their epidemiology, mechanism, clinical presentation and differential diagnosis, risk factors, morbidity and mortality, and prevention and management are discussed. For many of these disorders, treatment inconsistently provides benefit, and therefore, primary prevention is essential. Clinicians and other healthcare professionals play a key role in the identification of patients with DIMDs, or those at risk, and in implementing prevention and treatment plans.

scholarly journals Drug-Induced Methemoglobinemia: a Case Report and Review of Literature

2014 ◽  
Vol 2 (5) ◽  
pp. 34 ◽  
Author(s):  
Ahmed Zedan ◽  
Sabry Omar ◽  
Mahmoud Fenire
Keyword(s):  
Case Report ◽  
Clinical Presentation ◽  
Diagnostic Procedures ◽  
Blood Levels ◽  
Review Of Literature ◽  
Drug Induced ◽  
Upper Gi ◽  
Life Threatening ◽  
Upper Gi Endoscopy ◽  
Life Threatening Event

Drugs, including those used during diagnostic procedures, can have adverse effects and potentially serious side-effects, especially in complicated patients with significant comorbidity. Benzocaine is frequently used as an oropharyngeal anesthetic agent during bronchoscopy, transesophageal echocardiography, and upper GI endoscopy and can cause methemoglobinemia, a potentially life-threatening event if not diagnosed and treated quickly. Co-oximetry is the gold standard for the diagnosis of methemoglobinemia and can quantitate blood levels, which in turn correlate with the clinical presentation and the urgency for treatment. Methylene blue is the treatment of choice for methemoglobinemia. In this case report we discuss the pathophysiology, the clinical presentation, the diagnosis, and the treatment of benzocaine-induced methemoglobinemia.

scholarly journals Clinical evaluation of Amrita Ghrita Sneha-Pana followed by Pippalyadi Yoga Virechana in the management of Vicharchika (chronic dermatitis)

2020 ◽  
Vol 5 (06) ◽  
pp. 1-9
Author(s):  
Pritu Tiwari ◽  
Abhishek Bhattacharjee ◽  
Parashara Murali Krishna
Keyword(s):  
Clinical Presentation ◽  
Assessment Tool ◽  
Treatment Modalities ◽  
Drug Induced ◽  
Standard Assessment ◽  
Post Test ◽  
Analyse Data ◽  
Data Result

Background: Vicharchika is a Kapha dominated Tridoshaja Kshudra Kustha (minor skin disease) primarily characterized by eruptions with hyperpigmentation, itching and profuse discharge, but sometimes there may be dryness with itching, marked linings and thickening of the skin. The clinical presentation of Vicharchika is very much similar to that of Chronic Dermatitis or Eczema. The incidence of the disease is high and the relapsing nature of the disease makes it difficult to cure. Though many treatment modalities are there but in many of the cases the outcome is not satisfactory and long-term conventional treatment increases the chance of drug induced complications. So, in search of an effective, safe and affordable treatment modality the present study was carried-out. Objective: To evaluate the effectiveness of Amrita Ghrita Sneha-pana followed by Pippalyadi Yoga Virecana in the management of Vicarcika (chronic dermatitis). Materials and Methods: An open level clinical trial with pre-test and post test design were carried out where 30 patients suffering from Vicharchika were registered and were treated with Amrita Ghrita Sneha-pana followed by Virechana with Pippalyadi Yoga. Follow-up was done for 60 days. Assessment was done on 0-day, 15th day, 30th day and 60th day based on the symptoms and standard assessment tool specially designed for Chronic Dermatitis (Eczema). Appropriate statistical methods were used to analyse data. Result: Statistically significant improvement was observed in the symptoms of the disease. Conclusion: Amrita Ghrita Snehapana followed by Pippalyadi Yoga Virecana is found to be effective in the management of Vicharchika.

Headache as a presenting feature in patients with serotonin syndrome: A case series

Cephalalgia ◽  
2013 ◽  
Vol 34 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Sanjay Prakash ◽  
Pooja Belani ◽  
Aditi Trivedi
Keyword(s):  
Clinical Features ◽  
Serotonin Syndrome ◽  
Medication Overuse Headache ◽  
Case Series ◽  
Headache Disorders ◽  
Drug Induced ◽  
Positive Effects ◽  
Life Threatening ◽  
Serotonergic Drugs ◽  
Acute Headache

Introduction Serotonin syndrome (SS) is a drug-induced constellation of various clinical features that result from excess central serotonergic tone. The clinical features range from barely perceptible to life-threatening conditions. Cases We describe four patients with acute headache (four days to three weeks) who were receiving serotonergic drugs for other indications. There was a temporal relation between the administration of the serotonergic drugs and the development of the headaches. All four patients fulfilled the Hunter Serotonin Toxicity Criteria for SS. In parallel, two patients fulfilled the Sternbach’s criteria for SS. Discontinuation of the serotonergic drugs and the administration of cyprohepatadine led to complete improvement in three to seven days in all four patients. Discussion A review of the literature suggests that some overlaps exist in the pathophysiology between SS and headache disorders, including medication-overuse headache. The overlap is also in the management. The drugs found to be effective in SS (cyproheptadine, chlorpromazine, olanzapine, etc.) are also known to have positive effects on some headache disorders. Conclusion Physicians should consider the diagnosis of SS in patients with new onset or worsening headache after the addition of serotonergic drugs, especially in the presence of objective signs on examination suggestive of the disorder such as tremor, fever, hyperreflexia, diaphoresis or tachycardia.

Drug-Induced Movement Disorders

2015 ◽  
Vol 25 (2) ◽  
pp. 70-77
Author(s):  
Amy Lustig ◽  
Cesar Ruiz
Keyword(s):  
Movement Disorders ◽  
Medical Management ◽  
Disease Process ◽  
Underlying Disease ◽  
Extrapyramidal Symptoms ◽  
Drug Induced ◽  
General Overview ◽  
Management Approaches ◽  
Broad Understanding ◽  
Underlying Disease Process

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

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