Ataxia lithium treatment

Tremor is one of the most common adverse effects of lithium treatment, and it occurs with therapeutic doses. Propranolol and atenolol, which have been reported to be effective in essential tremor, also alleviate lithium-induced tremor. Other reported neurologic abnormalities include choreoathetosis, motor hyperactivity, ataxia, dysarthria, and aphasia. Psychiatric disturbances at toxic concentrations are generally marked by mental confusion and... 

Manto M-U, Jacquy J, Hildebrand J. Cerebellar ataxia in upper limbs tri ered ly addition of carbamazepine to lithium treatment Acta NeurolBelg (1996) 96,316-17. 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Irreversible neurotoxicity can occur at relatively low serum doses. Lang and Davis (2002) described the case of a 44 year old man who presented with a two-month history of dysarthria, ataxia and leg weakness whilst on maintenance lithium for bipolar disorder. He had significant cerebellar and pyramidal dysfunction. His serum lithium was 1.5 mmol/L, a moderate elevation for this patient. His recovery was only partial, leaving him mainly with cerebellar ataxia. The authors warned about the insidious onset of persistent neurotoxicity during routine treatment. 

A man on long-term treatment with lithium earbonate became confused within a day of starting to take doxycycline 100 mg twice daily. By the end of a week he had developed symptoms of lithium toxicity (ataxia, dysarthria, worsened tremor, fatigue, etc.). His serum-lithium levels had risen from a range of 0.8 to 1.1 mmol/L up to 1.8 mmol/L his renal function remained normal. He recovered when the doxycycline was withdrawn. ... 

Toxicity (confusion, ataxia, coarse tremor, incoordination, movement disorders, fever) was seen in a patient when lithium was added to fluoxetine treatment, although the serum-lithium levels remained within the therapeutic range. A woman maintained on clonazepam and then started on fluoxetine 20 mg then 40 mg daily, developed tremor and ataxia 6 days af-... 

In a study of patients with essential hypertension, two doses of nifedipine 20 mg did not affect single-dose lithium clearance, but nifedipine 40 to 80 mg daily for 6 and 12 weeks was found to decrease single-dose lithium clearance by 30%.A man, on lithium carbonate 1.5 g daily with a level of 0.8 mmol/L, developed ataxia and dysarthria 7 days after starting nifedipine 30 mg daily for 48 hours, then 60 mg daily. His lithium dose was reduced by 40%, but his serum-lithium level first increased to 1.1 mmol/L (about 2 weeks after starting the nifedipine), before restabilising at 0.9 mmol/L. In contrast, a patient taking lithium, who developed dysarthria and ataxia after verapamil was added to her treatment (see fcj below), was subsequently well controlled on lithium and nifedipine 40 mg daily... 

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