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Hanak AS, Malissin I, Poupon J, Risède P, Chevillard L, Mégarbane B. Electroencephalographic patterns of lithium poisoning: a study of the effect/concentration relationships in the rat. Bipolar Disord 2017; 19:135-145. [PMID: 28425670 DOI: 10.1111/bdi.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/02/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Lithium overdose may result in encephalopathy and electroencephalographic abnormalities. Three poisoning patterns have been identified based on the ingested dose, previous treatment duration and renal function. Whether the severity of lithium-induced encephalopathy depends on the poisoning pattern has not been established. We designed a rat study to investigate lithium-induced encephalopathy and correlate its severity to plasma, erythrocyte, cerebrospinal fluid and brain lithium concentrations previously determined in rat models mimicking human poisoning patterns. METHODS Lithium-induced encephalopathy was assessed and scored using continuous electroencephalography. RESULTS We demonstrated that lithium overdose was consistently responsible for encephalopathy, the severity of which depended on the poisoning pattern. Acutely poisoned rats developed rapid-onset encephalopathy which reached a maximal grade of 2/5 at 6 h and disappeared at 24 h post-injection. Acute-on-chronically poisoned rats developed persistent and slightly fluctuating encephalopathy which reached a maximal grade of 3/5. Chronically poisoned rats developed rapid-onset but gradually increasing life-threatening encephalopathy which reached a maximal grade of 4/5. None of the acutely, 20% of the acute-on-chronically and 57% of the chronically lithium-poisoned rats developed seizures. The relationships between encephalopathy severity and lithium concentrations fitted a sigmoidal Emax model based on cerebrospinal fluid concentrations in acute poisoning and brain concentrations in acute-on-chronic poisoning. In chronic poisoning, worsening of encephalopathy paralleled the increase in plasma lithium concentrations. CONCLUSIONS The severity of lithium-induced encephalopathy is dependent on the poisoning pattern, which was previously shown to determine lithium accumulation in the brain. Our data support the proposition that electroencephalography is a sensitive tool for scoring lithium-related neurotoxicity.
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Affiliation(s)
- Anne-Sophie Hanak
- Inserm, UMR-S1144, Paris, France.,Université Paris-Descartes, Paris, France.,Université Paris-Diderot, Paris, France
| | - Isabelle Malissin
- Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, Paris, France
| | - Joël Poupon
- Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Laboratoire de Toxicologie Biologique, Paris, France
| | - Patricia Risède
- Inserm, UMR-S1144, Paris, France.,Université Paris-Descartes, Paris, France.,Université Paris-Diderot, Paris, France
| | - Lucie Chevillard
- Inserm, UMR-S1144, Paris, France.,Université Paris-Descartes, Paris, France.,Université Paris-Diderot, Paris, France
| | - Bruno Mégarbane
- Inserm, UMR-S1144, Paris, France.,Université Paris-Descartes, Paris, France.,Université Paris-Diderot, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, Paris, France
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Moreira J, Geoffroy PA. Lithium and bipolar disorder: Impacts from molecular to behavioural circadian rhythms. Chronobiol Int 2016; 33:351-73. [DOI: 10.3109/07420528.2016.1151026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Joyce G. Small
- Indiana University School of Medicine, Larue D. Carter Memorial Hospital, 1315 West Tenth Street, Indianapolis, Indiana 46202
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Abstract
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has well-described rapid antidepressant effects in clinical studies of individuals with treatment-resistant major depressive disorder (MDD). Preclinical studies investigating the effects of ketamine on brain-derived neurotrophic factor (BDNF) and on sleep slow wave activity (SWA) support its use as a prototype for investigating the neuroplastic mechanisms presumably involved in the mechanism of rapidly acting antidepressants. This review discusses human EEG slow wave sleep parameters and plasma BDNF as central and peripheral surrogate markers of plasticity, and their use in assessing ketamine's effects. Acutely, ketamine elevates BDNF levels, as well as early night SWA and high-amplitude slow waves; each of these measures correlates with change in mood in depressed patients who respond to ketamine. The slow wave effects are limited to the first night post-infusion, suggesting that their increase is part of an early cascade of events triggering improved mood. Increased total sleep and decreased waking occur during the first and second night post infusion, suggesting that these measures are associated with the enduring treatment response observed with ketamine.
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