Arousal syndrome

In addition to disturbances in endocrine function, the sympathetic nervous system is probably involved in the pathogenesis of an arousal syndrome involving neuroendocrine and autonomic centres (Davy 2004). 

Mosko S, Richard C, McKenna J. Infant arousals during mother-infant bed sharing implications for infant sleep and sudden infant death syndrome research. Pediatrics 1997 100 841-849. 

Later, in his safety update of the NDA on October 17, 1986, Kapit spoke of several cases of a syndrome of fluoxetine-induced hyper-arousal and excessive stimulation... [that] resemble episodes of stimulant drug intoxication. It was especially likely to occur at higher doses, but it could occur at the standard 20 mgs. The state of overstimulation included anxiety, agitation, insomnia, headache, confusion, dizziness, obnubilation [mental clouding], memory dysfunction, tremor, impaired motor coordination. Hyperactivity, hypomania, and mania may sometimes occur. In overdose, the drug produces an even more flagrant stimulant syndrome culminating in seizures. Thus there is a continuum of stimulation effects. 

Piracetam 80-100 mg/day for 4 months has been evaluated in a randomized, double-blind, placebo-controlled, crossover study in 25 children with Down syndrome (11). Piracetam did not enhance cognition or behavior but was associated with adverse events 18 children completed the study, 4 withdrew, and 3 were excluded at baseline. The adverse events were related to the nervous system and included aggression (n = 4), agitation/irritability (n — 2), sexual arousal (n = 2), poor sleep (n — 1), and reduced appetite (n = 1). 

Extreme Caution History of sleep apnea, young children, family history of sudden infant death syndrome (SIDS), those difficult to arouse from sleep... 

Physical examination may be normal or show a blue or red mass behind the tympanic membrane. There is no significant lateralization to either ear. Bilateral lesions, either synchronous or asynchronous, have been described but are exceptional and should always arouse suspicion of Von-Hippel-Lindau disease (VHLD). Preliminary data indicate that at least 15% of all ELSTs are associated with VHLD and that the ELST is just another expanding list of lesions associated with this syndrome. ... 

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