Tremor after long term lithium treatment; is it cortical myoclonus?

Cerebellum & Ataxias

Panagiotis Zis¹  Zoe Charlotte Unwin¹  Ptolemaios Georgios Sarrigiannis¹  Marios Hadjivassiliou²  Daniel J. Blackburn²  Aijaz A. Khan²  Nigel Hoggard³  John Yianni⁴  Yifan Zhao⁵  Stephen A. Billings⁶ 

[1] 0000 0000 9422 8284, grid.31410.37, Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Floor N., Sheffield, UK;0000 0000 9422 8284, grid.31410.37, Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;0000 0000 9422 8284, grid.31410.37, Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;0000 0000 9422 8284, grid.31410.37, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;0000 0001 0679 2190, grid.12026.37, Through-life Engineering Services Centre, Cranfield University, MK43 0AL, Bedford, UK;0000 0004 1936 9262, grid.11835.3e, Department of Automatic Control and Systems Engineering, University of Sheffield, S1 3JD, Sheffield, UK;

关键词: Lithium;    Cerebellar ataxia;    Cortical myoclonus;    Gluten sensitivity;    JLA;    MRS;   

DOI  :  10.1186/s40673-019-0100-y

来源: publisher

【 摘 要 】

IntroductionTremor is a common side effect of treatment with lithium. Its characteristics can vary and when less rhythmical, distinction from myoclonus can be difficult.MethodsWe identified 8 patients on long-term treatment with lithium that developed upper limb tremor. All patients were assessed clinically and electrophysiologically, with jerk-locked averaging (JLA) and cross-correlation (CC) analysis, and five of them underwent brain MRI examination including spectroscopy (MRS) of the cerebellum.ResultsSeven patients (6 female) had action and postural myoclonus and one a regular postural and kinetic tremor that persisted at rest. Mean age at presentation was 58 years (range 42–77) after lengthy exposure to lithium (range 7–40 years). During routine monitoring all patients had lithium levels within the recommended therapeutic range (0.4-1 mmol/l). There was clinical and/or radiological evidence (on cerebellar MRS) of cerebellar dysfunction in 6 patients. JLA and/or CC suggested a cortical generator of the myoclonus in seven patients. All seven were on antidepressants and three additionally on neuroleptics, four of them had gluten sensitivity and two reported alcohol abuse.ConclusionsA synergistic effect of different factors appears to be contributing to the development of cortical myoclonus after chronic exposure to lithium. We hypothesise that the cerebellum is involved in the generation of cortical myoclonus in these cases and factors aetiologically linked to cerebellar pathology like gluten sensitivity and alcohol abuse may play a role in the development of myoclonus. Despite the very limited evidence in the literature, lithium induced cortical myoclonus may not be so rare.

【 授权许可】

CC BY