Lithium encephalopathy

Fetzer J, Kader G, Danahy S. Lithium encephalopathy a clinical, psychiatric, and EEG evaluation. (1981) 138, 1622-3. 

A 62-year-old man took amiodarone for 2 years and developed hyperthyroidism carbimazole 40 mg/day, prednisolone, lithium, and colestyramine were ineffective and he died with hepatic encephalopathy and multiorgan failure. 

It is difficult to establish a relation between valproate encephalopathy and increased serum ammonium concentrations. Valproate-induced hyperammonemic encephalopathy has been reported in several single case reports, but still it is difficult to ascertain whether hyperammonemia or valproic acid is the cause of the encephalopathy. In one case valproate was used in combination with lithium, which in itself could have caused encephalopathy by displacement of protein binding or other mechanisms, regardless of hyperammonemia (1181). In a second case it was also impossible to evaluate the effect of hyperammonemia on the level of consciousness, since it involved a woman who took valproic acid (30 g) in addition to... 

Of as yet unknown consequence to the brain and nervous system, there are many studies indicating that valproic acid promotes a variety of potentially dangerous viruses (e.g., Fan et al., 2005). Both valproic acid and carbamazepine cause a small increase in the rate of major congenital malformations in infants (Wide et al., 2004). Acute and potentially fatal pancreatitis has been reported with valproic acid (e.g., Grauso-Eby et al., 2003). Liver failure is a known problem as well. Valproic acid is known to cause hyperammonemia with encephalopathy (e.g., McCall et al., 2004). Severe and even lethal skin disorders can occur with all of the antiseizure medications now used as mood stabilizers. The various adverse effects of valproic acid and other mood stabilizers are not nearly as benign as physicians believe in their eagerness to switch patients from lithium. 

A 66-year-old man presented comatose with an EEG suggestive of Creutzfeldt-Jakob encephalopathy after an 11-month history of progressive dementia and parkinsonism (188). Lithium (serum concentration 1.3 mmol/1), which he had been taking for 13 years,... 

A 59-year-old man taking lithium, haloperidol, and carbamazepine had impaired memory, impaired attention, and an encephalopathy-like pattern on the electroencephalogram that normalized when haloperidol was withdrawn (622). Olanzapine 5 mg/day was added, and 3 weeks later he became disoriented. Surprisingly, the olanzapine was continued and he remained disoriented. 

Use caution when combining with lithium (may produce encephalopathy). ... 

Lithium Neurotoxicity (delirium seizures, encephalopathy) or increased extrapyramidal symptoms... 

Bradley JE, Baumgartner RJ Subsequent mental development of children with lead encephalopathy, as related to type of treatment. J Pediatr 53 311-315,1958 Bruhl HH, Foni J, Lee YH, et al Plasma concentrations of magnesium, lead, lithium, copper, and zinc in mentally retarded persons. American Journal of Mental Deficiency 92 103-111, 1987... 

Boudouresques G, Poncet M, Ali Cherif A, Tafani B, Boudouresques. Encephalopathie aigue, au cours d untraitement associantphenothiazine et lithium. Une nouvelle observation avec lithemie basse. NouvPresseMed( 9%0) 9, 2580. 

Cantor CH. Encephalopathy witii lithium and thioridazine in combination. MetfJylus/(1986) 144, 164-5. 

Several case reports suggest that some patients taking olanzapine and lithium may develop adverse reactions (neuroleptic malignant syndrome or serotonin syndrome, encephalopathy, priapism) without raised serum lithium levels. One study found no pharmacokinetic interaction between the drugs, but another analysis suggested that lithium may reduce olanzapine plasma levels. 

A 59-year-old man who had been diagnosed with encephalopathy and confusion while taking a combination of carbamazepine, haloperidol and lithium (therapeutic lithium level), developed similar symptoms when he was later given lithium with olanzapine. Another elderly patient who had taken lithium for 7 years, developed severe delirium and extrapyramidal... 

A study, undertaken to confirm the involvement of the cytochrome P450 isoenzyme CYT2D6 in the metabolism of trazodone, found that when 11 depressed patients were given trazodone 150 to 300 mg at bedtime for 18 weeks, and then with thioridazine 20 mg twice daily for one week, the plasma levels of the trazodone and its active metabolite, /w-chlorophenyl-piperazine, rose by 36% and 54%, respectively. No adverse reactions were described. In contrast, a case of fatal hepatic necrosis with cholestasis has been attributed to the concurrent use of trazodone and phenothiazines. A 72-year-old woman taking trifluoperazine, trazodone and lithium carbonate developed an elevated alanine aminotransferase level. Trifluoperazine was replaced with thioridazine, but 9 weeks later she became jaundiced and developed hepatic encephalopathy, and died 6 weeks after the onset of jaundice. The authors consider that the combination of the phenothiazines and trazodone were the cause of her hepatic necrosis both phenothiazines and trazodone have been reported to individually cause hepatic adverse effects. ... 

A complicated case of thyroiditis and Hashimoto s encephalopathy has been associated with lithium [51 ]. 

A 61-year-old woman with type II bipolar illness, who was taking levothyroxine for thyroiditis, developed an encephalopathy within 40 days of starting to take lithium. Her serum antithyroid antibodies were raised and antithyroid antibodies were detectable in the cerebrospinal fluid. She improved with a course of methylprednisolone. 

A 73-year-old man taking lithium for bipolar II disorder (serum concentration 0.8 mmol/1) developed confusion, dysarthria, gait disturbance, muscle stiffness, and twitching [52 ]. A brain CT scan was consistent with vascular encephalopathy. Peripheral electromyography (EMG) showed many intermittent spontaneous motor unit discharges in doublets, triplets, and multiplets, consistent with peripheral nerve hyperexcitability. The EMG normalized after withdrawal of lithium. 

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