Lithium neurotoxicity

As noted earlier, lithium is contraindicated in patients with unstable congestive heart failure or the sick sinus node syndrome ( 307, 328). In older patients or those with prior cardiac histories, a pretreatment ECG should be obtained. Except for the potential adverse interactions with diuretics, the concomitant use of other cardiac drugs is generally safe. Because verapamil may lower serum levels of lithium, however, more careful monitoring may be required to assure continued therapeutic effects (329). Some data also indicate that verapamil may predispose to lithium neurotoxicity. Conversely, increased lithium levels leading to toxicity has occurred with methyidopa and enalapril. When antihypertensive therapy is necessary, b-blockers are a reasonable choice when lithium is coadministered. 

Originally, it was thought that, except in extreme cases, lithium-induced neurotoxicity was reversible. However, it eventually became apparent that many patients develop irreversible brain damage and dysfunction, often involving the cerebellum (Grignon et al., 1996). In the last two decades, researchers have defined a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). Adityanjee et al. (2005) reviewed the literature from 1965 to 2004 for cases of lithium neurotoxicity with the persistence of sequelae for at least 2 months after cessation of treatment. They found 90 cases of SILENT, with persistent cerebellar dysfunction as the most commonly reported persistent aftereffect. These... 

Lang, E., Davis, S. (2002). Lithium neurotoxicity The development of irreversible neurological impairment despite standard monitoring of serum lithium levels. Journal of Clinical Neuroscience, 9, 308-309. 

Lecamwasam, D., Synek, B., Moyles, K., Ghose, K. (1994). Chronic lithium neurotoxicity presenting as Parkinson s disease. International Clinical Psychopharmacology, 8, 127-129. 

Non-reversible lithium neurotoxicity continues to be reported (165,166), including a case of lithium overdose (serum lithium concentration 3.9 mmol/1) with persistent severe ataxia for 9 months that improved markedly when inadvertently treated with high-dose buspirone (120-160 mg/day) (167). 

Another patient who developed cerebellar symptoms consistent with lithium neurotoxicity despite a low therapeutic serum concentration (0.5 mmol/1) was more fortunate, as the symptoms resolved promptly when lithium was withdrawn (180). 

Reports of lithium neurotoxicity resulting from interaction with ketorolac have been published (SEDA-22,117)... 

Miao YK. Lithium neurotoxicity within the therapeutic serum range. Hong Kong J Psychiatry 2002 12 19-22. 

Garcia-Resa E, Blasco Fontecilla H, Valbuena Briones A. Sindrome de neurotoxicidad irreversible por litio. [Non reversible lithium neurotoxicity a case report.] Med Clin (Bare) 2001 116(9) 357. 

Kumar R, Deb JK, Sinha VK. Lithium neurotoxicity at therapeutic level—a case report. J Indian Med Assoc 1999 97(ll) 473-4. 

Kores B, Lader MH. Irreversible lithium neurotoxicity an overview. Clin Neuropharmacol 1997 20(4) 283-99. 

Reports of lithium neurotoxicity resulting from interaction with ketorolac have been published (SEDA-22,117) (554). In five male volunteers, ketorolac 10 mg qds for 5 days increased lithium AUC by 24% and increased the incidence and severity of lithium-related adverse effects (555). 

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

Lithium Neurotoxicity with litihum and CBZ (not associated with increase in lithium level)... 

Lithium Neurotoxicity—confusion, ataxia, dizziness, tremor, absence, seizures... 

Emilien G, Maloteaux JM. Lithium neurotoxicity at low therapeutic doses h5TX3lheses fw causes and mechanism of action following a retrospective analysis of published case reports. Acta Neurol Belg (1996) 96, 281-93. 

Netto 1, Phutane VH. Reversible lithium neurotoxicity review of the literature. Prim Care Companion CNS Disord 2012 14(1). PCC.llr01197. ] Baek JH, Kinrys G, Nierenberg AA. Lithium tremor revisited pathophysiology and treatment. Acta Psychiatr Scand 2014 129 17-23. 

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