Atrophy multisystem

Valproate toxicity has been reported to have caused a neurodegenerative condition that mimicked multisystem atrophy in a 67-year-old woman (15). 

In most cases, clinical diagnosis of PD is correct. Nevertheless, misdiagnoses do occur, especially if additional clinical signs (e.g. gaze paresis and pyramidal signs, which characterize multisystem atrophy (MSA)) are overlooked (Fahn, 1989 Hughles et al., 1992). 

Cases cf Neurotoxicity Toxicity at therapeutic or subtherapeutic levels was reported in three cases. In two of these cases, the role of lithium is questionable. In one case of a rapidly fatal presentation of neuroleptic malignant syndrome (NMS) in a 72-year-old woman whose lithium level was 1.5 mM, the authors report a lithium-induced fatal NMS because she was not prescribed an antipsychotic [84 ]. However, her presentation is also consistent with fatal catatonia, sepsis, or unknown consumption of an antipsychotic, none of which were ruled out, and all of which are more likely than lithium-induced NMS. A second case in which a delirium with dyspraxia, but not ataxia in a 57-year-old man with a lithium level of 0.44 mM, that resolved after discontinuation of botii lithium and tricyclic antidepressant medication, was felt to be an interaction between the lithium and the antidepressant [85 ]. Lithium may have played a role, but he had been on lithium for years, and had developed anticholinergic problems with quetiapine previously, suggesting that the anticholinei c effects of the tricyclic antidepressant were more important in the delirium than the lithium. The third case of a 65-year-old man with multisystem atrophy becoming considerably worse with lithium at a level of 1.1 mM, is much more likely to represent lithium-related neurotoxicity at therapeutic levels [86 ]. 

Babinsky E, Levene RS. Multisystem atrophy made worse by lithium treatment in a hospice patient a case report. Am J Hosp Palliat Med 2012 29(7) 570-3. 

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