Myoclonic jerking

Similarly, convulsive seizures and a sustained epileptic state persisted after stomach contents were pumped and activated charcoal and anticonvulsive medication were administered in a 43-year-old man who ingested approximately 260 mg/kg endosulfan (Boereboom et al. 1998). At 4 days after exposure, the man was pronounced brain dead, and autopsy revealed cerebral hernia from massive cerebral edema. Eight additional accidental and/or intentional cases of acute poisoning with endosulfan resulting in adverse neurological effects have been reported in more recent studies, six by Blanco-Coronado et al. (1992), one by Lo et al. (1995), and one by Pradhan et al. (1997) two out of the eight resulted in death. Tonic-clonic convulsions were seen in the Blanco-Coronado et al. (1992) cases, whereas Lo et al. (1995) reported the development of muscle fasciculations and episodes of convulsions in their case. In the case reported by Pradhan et al. (1997), the patient had consumed about 75 mL of hquid endosulfan (35% w/v). In this case, in addition to tonic-clonic seizures and myoclonic jerks, the patient developed... 

Clonazepam, a typical 1 4 benzodiazepine, is effective in absence seizures, myoclonic jerks and tonic-clonic seizures and given intravenously it attenuates status epilepticus. It is less sedative than phenobarbitone but tolerance develops and its withdrawal, as... 

Juvenile myoclonic epilepsy (JME) A primary generalized epilepsy syndrome that usually starts in the early to middle teenage years and has a strong familial component. Patients have myoclonic jerks and tonic-clonic seizures and may also have absence seizures. 

BC, a 22-year-old woman, was diagnosed 2 years ago with juvenile myoclonic epilepsy. She has been treated with valproate 1500 mg/day. Since starting valproate she has gained 45 pounds (20.5 kg), continues to have occasional myoclonic jerks, had a generalized tonic-clonic seizure 3 months ago, and is sexually active. Additionally, she complains of easily falling asleep during the day. Due to adverse effects, poor seizure control, and the risk of birth defects with valproate, the decision is made to switch to a different antiepileptic drug. 

Intrauterine seizures may occur. The electroencephalogram often displays a hypsarrhythmia or a burst-suppression pattern. Patients display myoclonic jerks, hiccuping and a profound hypotonia. The few patients who survive past the first week usually sustain profound mental retardation and neurological disability. Brain imaging shows atrophy and a loss of myelin. Rarely, patients present later in life with psychomotor retardation and growth failure. Others have had initial normal development followed by a progressive loss of developmental milestones. Some patients have manifested spinocerebellar degeneration and other symptoms of motor dysfunction [27],... 

Myoclonic jerks are brief shock-like muscular contractions of the face, trunk, and extremities. They may be isolated events or rapidly repetitive. 

No real practical dosage limits with opioids mentioned can be titrated to patient response. If myoclonic jerking occurs, consider switching to alternative opioid. 

In humans, early symptoms of intoxication may include headache, dizziness, nausea, vomiting, malaise, and myoclonic jerks of the limbs clonic and tonic convulsions and sometimes coma follow and may occur without the premonitory symptoms. A suicidal person who ingested 25.6mg/kg developed convulsions within 20 minutes that persisted recurrently until large amounts of barbiturates had been administered. Hematuria and azotemia occurred the day after ingestion and continued for 18 days. Liver function studies were within normal limits except for an elevated icterus index an electroencephalogram revealed generalized cerebral dysrhythmia, which returned to normal after 5 months. ... 

A number of poisonings, including a few fatalities, have occurred among workers involved in spraying or manufacture of dieldrin. Early symptoms of intoxication may include headache, dizziness, nausea, vomiting, malaise, sweating, and myoclonic jerks of the... 

Sudden, brief, shocklike contractions of musculature (myoclonic jerks)... 

Lorazepam Flurazepam Meprobamate Methaqualone Myoclonic jerks Agitation, anxiety Seizure (rarely) ... 

Case Example A 48-year-old bipolar woman, stabilized on lithium 1,200 mg/day for the past 6 months, had a plasma level that varied between 0.8 and 1.0 mEq/L. She developed a recurrence of her rheumatoid arthritis, for which her internist prescribed ibuprofen (800 mg t.i.d.). A week later, she was brought to the emergency room in a confused, disoriented, and lethargic state. She was also ataxic and had periodic generalized myoclonic jerks. TDM revealed a lithium level of 4.0 mEq/L, and despite a rapid fall to under 0.5 mEq/L with plasma dialysis, her neurological status continued to deteriorate. After 5 days, she died. 

Within 30 minutes and lasting for perhaps 12 hours, there is intoxication, nausea, vomiting, coma, convulsions, nystagmus, papilledema, depressed reflexes, myoclonic jerks, and tetanic contractions. Permanent optic atrophy may occur. 

Several members of the benzodiazepine group are effective in treating epilepsy, but most are limited because of problems with sedation and tolerance. Some agents such as diazepam (Valium) and lorazepam (Ativan) are used in the acute treatment of status epilepti-cus (see Treatment of Status Epilepticus ), but only a few are used in the long-term treatment of epilepsy. Clonazepam (Klonopin) is recommended in specific forms of absence seizures (e.g., the Lennox-Gastaut variant) and may also be useful in minor generalized seizures such as akinetic spells and myoclonic jerks. Clorazepate (Tranxene) is another benzodiazepine that is occasionally used as an adjunct in certain partial seizures. 

The high levels recorded in the basal ganglia and cerebellum, regions that coordinate motor functions, strongly suggest that the cannabinoid-anandamide system is involved in this activity. This is supported by the wide spectrum of neurological effects of cannabis or THC in laboratory animals (impaired coordination and balance, decreased muscle tone and reflexes, and, at higher doses, tremor, myoclonic jerks, muscle spasms, and convulsions). In humans, uncoordinated movements, muscle weakness, and tremulousness are frequently observed after cannabis use. 

Benzene hexachloride Hyperexcitability, neurologic disorders, myoclonic jerks, aplastic anemia, hepatotoxicity, neurotoxicity, cerebral seizures... 

Heptachlor Myoclonic jerking, psychological disorders, irritability, anxiety, carcinogenicity... 

Patients with acute and chronic Al encephalopathy can demonstrate unilateral or bilateral myoclonic jerks of the extremities for several months in the chronic form and days to weeks in the acute form, followed by convulsions and coma even when the exposure is terminated, ft seems as if brain pathology reaches a point of no return which results in frequent epileptic insults and inevitably leads to coma and death, either due to superimposed infections like aspiration pneumonia, or pulmonary edema due to cardiac toxicity. Recovery is exceptional in severe cases. In the past, reports showed that the early stages of chronic Al encephalopathy progressed to death, mainly because the most important source of Al, namely the dialysis fluid contamination, was not recognized as such and the exposure continued for months to years [10-17, 19-42]. 

Coma and death in a high percentage of cases c) Movement disorder 100% Seizures 90% Myoclonic jerks 30% II. Musculoskeletal symptoms Absent... 

Seizures and myoclonic jerks do not or hardly respond on benzodiazepines Severe cases probably do not respond to desferri-oxamine. The less symptoms, the better the outcome with earlydesferrioxamine treatment Aluminum gastroenteropathy Acute aluminum gastroenteropathy... 

Benzodiazepines can be very effective in treating myoclonic jerks and seizures in the early stages In early stage reversible with desferrioxamine... 

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