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Panda PK, Sharawat IK, Panda P, Dawman L, Kasinathan A. Clinico-laboratory characteristics and outcome of patients with eucalyptus oil-induced/provoked seizures: A case series and systematic review of the published patients. Trop Doct 2021; 51:518-522. [PMID: 34282989 DOI: 10.1177/00494755211032095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Seizures triggered by skin application, inhalation or ingestion of over-the-counter medications containing eucalyptus oil are known. We report five children who suffered likewise. We made a systematic search for all reported cases and performed a pooled analysis to provide a comprehensive estimate of the type of seizures, their management and outcome. In 110 cases (49 children), inhalational use was the most predominant, generalised tonic-clonic (the commonest semiology) and levetiracetam was the most common anti-convulsant treatment used. Most cases had an uneventful recovery. Adults were less likely to have prolonged and multiple seizures, requiring intensive care or mechanical ventilation.
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Affiliation(s)
- Prateek Kumar Panda
- Assistant Professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Indar Kumar Sharawat
- Assistant Professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Pragnya Panda
- Assistant Professor, Department of Neurology, King George Medical University, Lucknow, India
| | - Lesa Dawman
- Assistant Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ananthanarayanan Kasinathan
- Assistant Professor, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Dawman L, Yadav A, Sharawat IK, Srinivasan S, Sharma A, Tiewsoh K. Trichotillomania in a child with nephrotic syndrome: An unusual steroid induced psychiatric manifestation. Trop Doct 2021; 51:591-593. [PMID: 34018888 DOI: 10.1177/00494755211016126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Steroid-induced psychosis is a known serious adverse effect seen commonly in adults but less commonly in children. We present a seven-year-old girl with steroid-dependent nephrotic syndrome who developed abnormal behaviour, trichotillomania, alopecia and mood changes. She was investigated to rule out other causes and treated with tapering steroids, fluoxetine and olanzapine. A marked improvement was noted after two months. Patients on long term or high dose steroids should be monitored for adverse psychological effects of steroids, as early recognition and intervention can improve the outcome.
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Affiliation(s)
- Lesa Dawman
- Assistant Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arti Yadav
- Junior Resident, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar K Sharawat
- Associate Professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Santhiya Srinivasan
- Senior Resident, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akhilesh Sharma
- Associate Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Assistant Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Secondary focal hyperhidrosis is usually due to peripheral or central neuronal defects and is a complex dysfunction of the parasympathetic and sympathetic nervous system. Palmoplantar hyperhidrosis has been described with various types of polyneuropathies such as diabetic but has not previously been described with isoniazid. We report a 15-year-old boy, being followed for neurotuberculosis, who presented with burning sensation and hyperhidrosis of both palms and soles five months after starting antitubercular therapy. With oral pyridoxine supplementation, the paraesthesia and hyperhidrosis reduced to minimal severity over the next four months. Before commencing antiperspirants, simple pyridoxine supplementation can lead to the reversal of symptoms in such cases.
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Affiliation(s)
- Prateek K Panda
- Assitant professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Senior resident, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Associate professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Sonalika Mehta
- Assitant professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Senior resident, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Associate professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Indar K Sharawat
- Assitant professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Senior resident, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.,Associate professor, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
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Alfawaz S, Alattas N, Alhammadi M, Waqar S, Al Alola S. Acute psychosis secondary to isoniazid in pediatric pulmonary tuberculosis: A case report and literature review. Int J Pediatr Adolesc Med 2020; 7:196-198. [PMID: 33319019 PMCID: PMC7729223 DOI: 10.1016/j.ijpam.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
Isoniazid (INH) is a first-line tuberculosis (TB) drug and is currently recommended as part of active and latent TB treatment in all ages. INH adverse reactions range from mild hepatitis to severe neurological symptoms and psychosis. Since its introduction in the 1950s, many case reports have explored INH-induced psychosis. We describe a 12-year-old girl with acute onset hallucinations and delusions as a rare complication of INH and review previous case reports and identified risk factors. Pediatricians need to be aware of this less common side effect as they work through a differential of acute psychosis in children.
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Affiliation(s)
- Saleh Alfawaz
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nadia Alattas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moza Alhammadi
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Saadia Waqar
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sulaiman Al Alola
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
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Panda PK, Sharawat IK, Choudhury S. New-onset Seizures Due to Heroin Addiction. Ann Indian Acad Neurol 2020; 24:103-105. [PMID: 33911397 PMCID: PMC8061516 DOI: 10.4103/aian.aian_147_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Prateek Kumar Panda
- Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shinjini Choudhury
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sharawat IK, Dawman L, Panda PK. A Toddler with Recurrent Episodes of Unexplained Irritability: Will you Consider Neuro Imaging? Indian J Pediatr 2020; 87:402-403. [PMID: 31781956 DOI: 10.1007/s12098-019-03112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Lesa Dawman
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Isoniazid-Induced Acute Psychosis in a Patient with Pleural Tuberculosis. Case Rep Psychiatry 2019; 2019:4272941. [PMID: 30906613 PMCID: PMC6393917 DOI: 10.1155/2019/4272941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS). Isoniazid is highly bactericidal against replicating tubercle bacilli and is a component of all antituberculous chemotherapeutic regimens currently recommended by the World Health Organization (WHO). Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazid-induced psychosis, although uncommon, has been reported in the literature. We describe the case of a 21-year-old black woman, with no prior psychiatric history, who developed a psychotic episode four days after she was started on isoniazid. This case highlights psychosis arising as a possible adverse effect of isoniazid and the importance of remaining vigilant when antituberculous therapy is started.
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Seizures following Intoxication with a Common Antituberculosis Drug. Case Rep Pediatr 2019; 2019:8972574. [PMID: 30956835 PMCID: PMC6425408 DOI: 10.1155/2019/8972574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/18/2019] [Indexed: 11/30/2022] Open
Abstract
Isoniazid is an antimycobacterial agent commonly prescribed in most tuberculosis chemotherapy regimens. Its side effects are widely known including mainly liver toxicity and peripheral neuropathy. The toxic effects of isoniazid are dose-related. Toxic doses are estimated at 35–40 mg/kg and fatal doses at 150 mg/kg. Treatment consists primarily of basic life support, antiepileptic drugs, and pyridoxine. The case is of one of the children with intentional isoniazid poisoning, the drug belonging to an uncle currently under antituberculosis treatment, resulting in tonic-clonic seizures. During her hospitalization in the paediatric intensive care unit, her neurological status as well as her lab values was closely monitored, and despite initial deterioration, the patient was discharged from critical care a week after full recovery.
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