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Christen M, Gutierrez-Quintana R, James M, Faller KME, Lowrie M, Rusbridge C, Bossens K, Mellersh C, Pettitt L, Heinonen T, Lohi H, Jagannathan V, Leeb T. A TNR Frameshift Variant in Weimaraner Dogs with an Exercise-Induced Paroxysmal Movement Disorder. Mov Disord 2023; 38:1094-1099. [PMID: 37023257 DOI: 10.1002/mds.29391] [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] [Received: 12/07/2022] [Revised: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Some paroxysmal movement disorders remain without an identified genetic cause. OBJECTIVES The aim was to identify the causal genetic variant for a paroxysmal dystonia-ataxia syndrome in Weimaraner dogs. METHODS Clinical and diagnostic investigations were performed. Whole genome sequencing of one affected dog was used to identify private homozygous variants against 921 control genomes. RESULTS Four Weimaraners were presented for episodes of abnormal gait. Results of examinations and diagnostic investigations were unremarkable. Whole genome sequencing revealed a private frameshift variant in the TNR (tenascin-R) gene in an affected dog, XM_038542431.1:c.831dupC, which is predicted to truncate more than 75% of the open read frame. Genotypes in a cohort of 4 affected and 70 unaffected Weimaraners showed perfect association with the disease phenotype. CONCLUSIONS We report the association of a TNR variant with a paroxysmal dystonia-ataxia syndrome in Weimaraners. It might be relevant to include sequencing of this gene in diagnosing humans with unexplained paroxysmal movement disorders. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Matthias Christen
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Rodrigo Gutierrez-Quintana
- Small Animal Hospital, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | - Kiterie M E Faller
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, United Kingdom
| | - Mark Lowrie
- Dovecote Veterinary Hospital, Derby, United Kingdom
| | - Clare Rusbridge
- School of Veterinary Medicine, University of Surrey, Surrey, United Kingdom
| | - Kenny Bossens
- Nesto Veterinary Referral Center Orion, Herentals, Belgium
| | - Cathryn Mellersh
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Louise Pettitt
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tiina Heinonen
- Department of Medical and Clinical Genetics, Department of Veterinary Biosciences, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
| | - Hannes Lohi
- Department of Medical and Clinical Genetics, Department of Veterinary Biosciences, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
| | - Vidhya Jagannathan
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Tosso Leeb
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Muacevic A, Adler JR. Bupropion-Induced Dystonia: A Case Report. Cureus 2022; 14:e29857. [PMID: 36337825 PMCID: PMC9627898 DOI: 10.7759/cureus.29857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Bupropion is one of the most commonly prescribed antidepressant medications by physicians all over the world. Because of its favorable sexual profile, it is used as an alternative to serotonin reuptake inhibitors (SSRIs). Its significance in smoking cessation is also well recognized. However, it is associated with a few side effects, such as dizziness, anxiety, tremors, nausea, and insomnia. We present the case of a 54-year-old chronic smoker who developed acute facial dystonia involving the temporomandibular joint (TMJ) after being prescribed 300 mg of bupropion. The Naranjo scale was used to assess the probability of bupropion-induced dystonia. Following the diagnosis, the drug was stopped, and the dystonia completely resolved within one week. At her follow-ups, the patient was found to have no recurrence of dystonia.
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Wadhokar OC, Patil DS. Current Trends in the Management of Temporomandibular Joint Dysfunction: A Review. Cureus 2022; 14:e29314. [PMID: 36277551 PMCID: PMC9579904 DOI: 10.7759/cureus.29314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
The temporomandibular joint (TMJ) is a synovial bi-condylar joint with 3 degrees of freedom. One-third of the adult population reportedly suffers from temporomandibular joint dysfunction (TMD). Females are more commonly affected than males. Almost 50% of TMD patients do not require any intervention, and the symptoms are self-limiting within one year after the onset; however, 75-80% of adults suffering from TMD require medical intervention and it takes up to three years for the complete remission of the symptoms. The clinical features of TMD are clenching, clicking, and locking of the jaw, and occlusion due to faulty posture. Based on the diagnostic criteria for temporomandibular disorder (DC/TMD) criteria proposed in the year 2014, the classification of TMD is done based on axis I and axis II diagnoses. This review aims to provide an overview of TMD and examine available treatment strategies for TMD. Various conservative treatment methods have been proven to be effective, including self-care strategies, dental treatment strategies, pharmacological treatment, physical therapy modalities, manual mobilization, electrotherapy and dry needling, relaxation techniques, intra-articular injections, cognitive behavioral therapy, and surgical corrections.
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4
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Ghadery CM, Kalia LV, Connolly BS. Movement disorders of the mouth: a review of the common phenomenologies. J Neurol 2022; 269:5812-5830. [PMID: 35904592 DOI: 10.1007/s00415-022-11299-1] [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] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Movement disorders of the mouth encompass a spectrum of hyperactive movements involving the muscles of the orofacial complex. They are rare conditions and are described in the literature primarily in case reports originating from neurologists, psychiatrists, and the dental community. The focus of this review is to provide a phenomenological description of different oral motor disorders including oromandibular dystonia, orofacial dyskinesia and orolingual tremor, and to offer management strategies for optimal treatment based on the current literature. A literature search of full text studies using PubMed/Medline and Cochrane library combined with a manual search of the reference lists was conducted until June 2021. Results from this search included meta-analyses, systematic reviews, reviews, clinical studies, case series, and case reports published by neurologists, psychiatrists, dentists and oral and maxillofacial surgeons. Data garnered from these sources were used to provide an overview of most commonly encountered movement disorders of the mouth, aiding physicians in recognizing these rare conditions and in initiating appropriate therapy.
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Affiliation(s)
- C M Ghadery
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - L V Kalia
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - B S Connolly
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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5
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Abstract
Accurate diagnosis and appropriate treatment of tardive dyskinesia (TD) are imperative, as its symptoms can be highly disruptive to both patients and their caregivers. Misdiagnosis can lead to incorrect interventions with suboptimal or even deleterious results. To aid in the identification and differentiation of TD in the psychiatric practice setting, we review its clinical features and movement phenomenology, as well as those of other antipsychotic-induced movement disorders, with accompanying links to illustrative videos. Exposure to dopamine receptor blocking agents (DRBAs) such as antipsychotics or antiemetics is associated with a spectrum of movement disorders including TD. The differential diagnosis of TD is based on history of DRBA exposure, recent discontinuation or dose reduction of a DRBA, and movement phenomenology. Common diagnostic challenges are the abnormal behaviors and dyskinesias associated with advanced age or chronic mental illness, and other movement disorders associated with DRBA therapy, such as akathisia, parkinsonian tremor, and tremor related to use of mood stabilizing agents (eg, lithium, divalproex). Duration of exposure may help rule out acute drug-induced syndromes such as acute dystonia or acute/subacute akathisia. Another important consideration is the potential for TD to present together with other drug-induced movement disorders (eg, parkinsonism, parkinsonian tremor, and postural tremor from mood stabilizers) in the same patient, which can complicate both diagnosis and management. After documentation of the phenomenology, severity, and distribution of TD movements, treatment options should be reviewed with the patient and caregivers.
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Sarkar AK, Nakamura S, Nakai K, Sato T, Shiga T, Abe Y, Hoashi Y, Inoue T, Akamatsu W, Baba K. Increased excitability of human iPSC-derived neurons in HTR2A variant-related sleep bruxism. Stem Cell Res 2022; 59:102658. [PMID: 34999422 DOI: 10.1016/j.scr.2022.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/05/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
Sleep bruxism (SB) is a sleep-related movement disorder characterized by grinding and clenching of the teeth during sleep. We previously found a significant association between SB and a single nucleotide polymorphism (SNP), rs6313, in the neuronal serotonin 2A receptor gene (HTR2A), and established human induced pluripotent stem cell (iPSC)-derived neurons from SB patients with a genetic variant. To elucidate the electrophysiological characteristics of SB iPSC-derived neural cells bearing an SB-related genetic variant, we generated ventral hindbrain neurons from SB patients and unaffected controls, and explored the intrinsic membrane properties of these neurons using the patch-clamp technique. We found that the electrophysiological properties of iPSC-derived neurons mature in a time-dependent manner in long-term control cultures. SB neurons exhibited higher action potential firing frequency, higher gain, and shorter action potential half duration. This is the first in vitro modeling of SB using patient-specific iPSCs. The revealed electrophysiological characteristics may serve as a benchmark for further investigation of pathogenic mechanisms underlying SB. Moreover, our results on long-term cultures provide a strategy to define the functional maturity of human neurons in vitro, which can be implemented for stem cell research of neurogenesis, and neurodevelopmental disorders.
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Affiliation(s)
- Avijite Kumer Sarkar
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
| | - Shiro Nakamura
- Department of Oral Physiology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
| | - Kento Nakai
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
| | - Taro Sato
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
| | - Takahiro Shiga
- Center for Genomic and Regenerative Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Yuka Abe
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
| | - Yurie Hoashi
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
| | - Tomio Inoue
- Department of Oral Physiology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
| | - Wado Akamatsu
- Center for Genomic and Regenerative Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Kazuyoshi Baba
- Department of Prosthodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
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Flueraşu MI, Bocşan IC, Țig IA, Iacob SM, Popa D, Buduru S. The Epidemiology of Bruxism in Relation to Psychological Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020691. [PMID: 35055514 PMCID: PMC8775973 DOI: 10.3390/ijerph19020691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
The aim of the present study was to establish the prevalence of sleep/awake bruxism among young students in Transylvania and to correlate the presence of this muscle activity with behavioral variations. This analytical, observational, cohort, cross-sectional, and prospective study involved 308 volunteers aged between 19 and 30 years of different nationalities, all students of the “Iuliu Hațieganu” University of Medicine and Pharmacy in Cluj-Napoca, Romania. Subjects were asked to complete an anonymous questionnaire which was structured in five sections. The results obtained from the questionnaires were analyzed separately for sleep bruxism and for awake bruxism. We did not find any statistically significant correlation between awake bruxism or sleep bruxism and age (p = 0.30 and p = 0.37, respectively), sex (p = 0.44 and p = 0.48, respectively), or nationality (p = 0.55 and p = 0.67, respectively). Only a high degree of stress and frustration (p = 0.035 and p = 0.020) was observed in European subjects except for the Romanians and the French, likely related to the difficulties of adapting to the language and lifestyle in Romania. Female sex was statistically significantly associated with an increased level of stress (p = 0.004), duty-related depression (p = 0.006), and duty-related anxiety (p = 0.003). Stress and anxiety can be favorable factors in the appearance of both types of bruxism; however, depression is associated only with awake bruxism.
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Affiliation(s)
- Mirela Ioana Flueraşu
- Department IV, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania; (M.I.F.); (S.M.I.); (S.B.)
| | - Ioana Corina Bocşan
- Department of Pharmacology, Toxicology and Clinical Pharmacology “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania;
| | - Ioan-Andrei Țig
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
| | - Simona Maria Iacob
- Department IV, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania; (M.I.F.); (S.M.I.); (S.B.)
| | - Daniela Popa
- Department IV, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania; (M.I.F.); (S.M.I.); (S.B.)
- Correspondence: ; Tel.: +40-744-349-278
| | - Smaranda Buduru
- Department IV, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania; (M.I.F.); (S.M.I.); (S.B.)
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Undeberg MR, McKeirnan KC, Easley D. Respecting the Patient's Choice: A Case of Possible Drug-Induced Parkinsonism. PHARMACY (BASEL, SWITZERLAND) 2022; 10:pharmacy10010010. [PMID: 35076621 PMCID: PMC8788564 DOI: 10.3390/pharmacy10010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
This report describes a case of likely drug-induced Parkinsonism (DIP) identified by the pharmacist. A 54-year-old female patient was referred by a physician to the pharmacist in a rural, integrated care team for a comprehensive medication review (CMR) to address the patient's concerns of possible Parkinson's disease (PD). While PD may occur over the progression of age, medications that affect dopamine transport can also cause DIP, a secondary form of Parkinson's disease. Although PD and DIP may be clinically indistinguishable, differentiation may be possible by reviewing a patient's medication history for any potential causative drugs correlating to the timeline of the onset of symptoms. In this case, the pharmacist reviewed the medication profile and identified medications that could be responsible for causing DIP, specifically bupropion. The pharmacist suggested discontinuing bupropion and identifying another option for treating depression. The patient appreciated the suggestion and education, but ultimately preferred continuing her bupropion therapy instead of discontinuing therapy or changing to an alternative agent. At a follow-up meeting with the pharmacist, not only was the patient still experiencing tremors despite taking carbidopa/levodopa, but additional medications known to be potential inducers of tremors were added to her regimen. Although the pharmacist repeatedly discussed DIP with the patient and believed stopping bupropion would determine whether her Parkinsonism was PD or DIP, ultimately the patient continued taking bupropion because of concerns related to depression severity and the impact on her well-being. The patient's wishes were respected.
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Affiliation(s)
- Megan R. Undeberg
- Pharmacotherapy Department, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA;
| | - Kimberly C. McKeirnan
- Pharmacotherapy Department, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA;
- Correspondence:
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Meikle CKS, Creeden JF, McCullumsmith C, Worth RG. SSRIs: Applications in inflammatory lung disease and implications for COVID-19. Neuropsychopharmacol Rep 2021; 41:325-335. [PMID: 34254465 PMCID: PMC8411309 DOI: 10.1002/npr2.12194] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) have anti-inflammatory properties that may have clinical utility in treating severe pulmonary manifestations of COVID-19. SSRIs exert anti-inflammatory effects at three mechanistic levels: (a) inhibition of proinflammatory transcription factor activity, including NF-κB and STAT3; (b) downregulation of lung tissue damage and proinflammatory cell recruitment via inhibition of cytokines, including IL-6, IL-8, TNF-α, and IL-1β; and (c) direct suppression inflammatory cells, including T cells, macrophages, and platelets. These pathways are implicated in the pathogenesis of COVID-19. In this review, we will compare the pathogenesis of lung inflammation in pulmonary diseases including COVID-19, ARDS, and chronic obstructive pulmonary disease (COPD), describe the anti-inflammatory properties of SSRIs, and discuss the applications of SSRIS in treating COVID-19-associated inflammatory lung disease.
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Affiliation(s)
- Claire Kyung Sun Meikle
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Justin Fortune Creeden
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.,Department of Psychiatry, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Cheryl McCullumsmith
- Department of Psychiatry, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Randall G Worth
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Rissardo JP, Caprara ALF. Cinnarizine- and flunarizine-associated movement disorder: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00197-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Cinnarizine (CNZ) and flunarizine (FNZ) belong to the calcium channel blockers class of medication.
Main text
The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CNZ/FNZ-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. One hundred and seventeen reports containing 1920 individuals who developed a CNZ/FNZ-associated MD were identified. The MD encountered were 1251 parkinsonism, 23 dyskinesias, 11 akathisia, 16 dystonia, and 5 myoclonus, and in the group not clearly defined, 592 extrapyramidal symptoms, 19 tremors, 2 bradykinesia, and 1 myokymia. The predominant sex was female with a percentage of 72.69% (466/641). The mean age was 74.49 (SD, 7.88) years. The mean CNZ dose was 148.19 mg (SD, 42.51) and for the FNZ dose, 11.22 mg (5.39). The mean MD onset and recovery were 1.83 years (SD, 1.35) and 3.71 months (SD, 1.26). In the subgroup of subjects that had improvement of the symptoms, the complete recovery was achieved within 6 months of the drug withdrawal in almost all subjects (99%). The most common management was drug withdrawal. A complete recovery was observed in 93.77% of the patients (437/466).
Conclusions
CNZ/FNZ-associated MD was extensively reported in the literature. Parkinsonism was the most well described. Myoclonus (MCL) was the poorest described MD with missing data about the neurological examination and electrodiagnostic studies. The knowledge of this disorder probably can contribute to the understanding of the other drug-induced MDs.
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Revet A, Montastruc F, Roussin A, Raynaud JP, Lapeyre-Mestre M, Nguyen TTH. Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database. BMC Psychiatry 2020; 20:308. [PMID: 32546134 PMCID: PMC7298955 DOI: 10.1186/s12888-020-02711-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants' classes. The objective of this study was to assess the putative association of each antidepressant and antidepressants' classes with movement disorders. METHODS Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders' reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders. RESULTS Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62-11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38-1.60). When comparing each of the classes of antidepressants with the others, a significant association was observed for all subtypes of movement disorders except restless legs syndrome with serotonin reuptake inhibitors (SRIs) only. Among antidepressants, mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan and fluvoxamine were associated with the highest level to movement disorders and citalopram, paroxetine, duloxetine and mirtazapine were the most frequently associated with movement disorders. An association was also found with eight other antidepressants. CONCLUSIONS A potential harmful association was found between movement disorders and use of the antidepressants mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan, fluvoxamine, citalopram, paroxetine, duloxetine, bupropion, clomipramine, escitalopram, fluoxetine, mianserin, sertraline, venlafaxine and vilazodone. Clinicians should beware of these adverse effects and monitor early warning signs carefully. However, this observational study must be interpreted as an exploratory analysis, and these results should be refined by future epidemiological studies.
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Affiliation(s)
- Alexis Revet
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, Faculté de Médecine, Toulouse, France.
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France.
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse cedex 9, France.
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, Faculté de Médecine, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
- CIC 1436, CHU de Toulouse, Toulouse, France
| | - Anne Roussin
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, Faculté de Médecine, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
- CIC 1436, CHU de Toulouse, Toulouse, France
| | - Jean-Philippe Raynaud
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse cedex 9, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, Faculté de Médecine, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
- CIC 1436, CHU de Toulouse, Toulouse, France
| | - Thi Thu Ha Nguyen
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, Faculté de Médecine, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
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Han K, Wang C, Zhong Z, Xu M, Zou X, Yu B, Wang K, Yao D. Characterisation of the relationships between rhythmic masticatory muscle activities and limb movements in patients with sleep bruxism. J Oral Rehabil 2019; 46:399-408. [PMID: 30588653 DOI: 10.1111/joor.12760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/25/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Kangning Han
- Jiangxi Mental Hospital Nanchang University Jiangxi China
- Queen Mary College Nanchang University Jiangxi China
- School of Pharmaceutical Sciences Nanchang University Jiangxi China
| | - Chuanying Wang
- Jiangxi Mental Hospital Nanchang University Jiangxi China
- Queen Mary College Nanchang University Jiangxi China
- School of Pharmaceutical Sciences Nanchang University Jiangxi China
| | - Zhijun Zhong
- Jiangxi Mental Hospital Nanchang University Jiangxi China
- School of Pharmaceutical Sciences Nanchang University Jiangxi China
| | - Miao Xu
- Jiangxi Mental Hospital Nanchang University Jiangxi China
- School of Pharmaceutical Sciences Nanchang University Jiangxi China
| | - Xueliang Zou
- Jiangxi Mental Hospital Nanchang University Jiangxi China
| | - Bin Yu
- Jiangxi Mental Hospital Nanchang University Jiangxi China
| | - Kelun Wang
- Center for Sensory‐Motor Interaction, Department of Health Science & Technology Aalborg University Aalborg Denmark
| | - Dongyuan Yao
- Jiangxi Mental Hospital Nanchang University Jiangxi China
- School of Pharmaceutical Sciences Nanchang University Jiangxi China
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13
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Hirano Y. Risk of Extrapyramidal Syndromes Associated With Psychotropic Polypharmacy. Ther Innov Regul Sci 2018. [DOI: 10.1177/2168479018808248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoko Hirano
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Minato-ku, Tokyo, Japan
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14
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Kamińska K, Lenda T, Konieczny J, Wardas J, Lorenc-Koci E. Interactions of the tricyclic antidepressant drug amitriptyline with L-DOPA in the striatum and substantia nigra of unilaterally 6-OHDA-lesioned rats. Relevance to motor dysfunction in Parkinson's disease. Neurochem Int 2018; 121:125-139. [PMID: 30290201 DOI: 10.1016/j.neuint.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
Antidepressant drugs are recommended for the treatment of Parkinson's disease (PD)-associated depression but their role in the modulation of L-DOPA-induced behavioral and neurochemical markers is poorly explored. The aim of the present study was to examine the impact of the tricyclic antidepressant amitriptyline and L-DOPA, administered chronically alone or in combination, on rotational behavior, monoamine levels and binding of radioligands to their transporters in the dopaminergic brain structures of unilaterally 6-OHDA-lesioned rats. Binding of [3H]nisoxetine to noradrenaline transporter (NET), [3H]GBR 12,935 to dopamine transporter (DAT) and [3H]citalopram to serotonin transporter (SERT) were analyzed by autoradiography. Amitriptyline administered alone did not induce rotational behavior but in combination with L-DOPA increased the number of contralateral rotations much more strongly than L-DOPA alone. The combined treatment also significantly increased the tissue dopamine (DA) content in the ipsilateral striatum and substantia nigra (SN) vs. L-DOPA alone. 6-OHDA-mediated lesion of nigrostriatal DA neurons drastically reduced DAT and NET bindings in the ipsilateral striatum. In the ipsilateral SN, DAT binding decreased while NET binding rose. SERT binding increased significantly mainly in the SN. Amitriptyline administered alone or jointly with L-DOPA had no effect on DAT binding on the lesioned side, significantly decreased SERT binding in the striatum and SN while NET binding only in the SN. Since in the DA-denervated striatum, SERT is mainly responsible for reuptake of L-DOPA-derived DA while in the SN, SERT and NET are involved, the inhibition of these transporters by antidepressant drugs may improve dopaminergic transmission and consequently motor behavior.
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Affiliation(s)
- Kinga Kamińska
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neuro-Psychopharmacology, 31-343, Kraków, Smętna Street 12, Poland
| | - Tomasz Lenda
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neuro-Psychopharmacology, 31-343, Kraków, Smętna Street 12, Poland
| | - Jolanta Konieczny
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neuro-Psychopharmacology, 31-343, Kraków, Smętna Street 12, Poland
| | - Jadwiga Wardas
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neuro-Psychopharmacology, 31-343, Kraków, Smętna Street 12, Poland
| | - Elżbieta Lorenc-Koci
- Institute of Pharmacology, Polish Academy of Sciences, Department of Neuro-Psychopharmacology, 31-343, Kraków, Smętna Street 12, Poland.
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D'Abreu A, Friedman JH. Tardive Dyskinesia-like Syndrome Due to Drugs that do not Block Dopamine Receptors: Rare or Non-existent: Literature Review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2018; 8:570. [PMID: 30191087 PMCID: PMC6125739 DOI: 10.7916/d8ff58z9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/10/2018] [Indexed: 12/01/2022]
Abstract
Background Although tardive dyskinesia (TD) is most commonly defined as a movement disorder caused by chronic exposure to dopamine‐receptor‐blocking drugs (DRBDs), it has also been thought to result from exposure to some non‐DRBDs. Methods We critiqued many reviews making the association between non‐DRBDs and a TD‐like syndrome and almost all case reports. We checked whether cases met criteria for the diagnosis of TD‐like syndrome and whether DRBDs had been excluded. Results We found that both tricyclic antidepressants and selective serotonin reuptake inhibitor antidepressants may unmask or exacerbate TD after prior exposure to or with concurrent use of DRBDs. We found support for its existence outside of this context to be extremely weak. Discussion There is little evidence that drugs other than DRBDs by themselves cause a TD syndrome; most reported cases appear to occur as a result of a “priming” effect induced by a DRBD, which is later unmasked.
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Affiliation(s)
- Anelyssa D'Abreu
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph H Friedman
- Department of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Sriharsha P, Gujjari AK, Dhakshaini MR, Prashant A. Comparative Evaluation of Salivary Cortisol Levels in Bruxism Patients Before and After Using Soft Occlusal Splint: An in vivo Study. Contemp Clin Dent 2018; 9:182-187. [PMID: 29875558 PMCID: PMC5968680 DOI: 10.4103/ccd.ccd_756_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Bruxism is defined as a nonfunctional activity or a parafunctional habit characterized by the unconscious repetitive motion of clenching and/or grinding of the teeth. Soft occlusal splints have been considered as the first-line strategy for treating nocturnal bruxism. Cortisol is a major steroid hormone secreted by fascicular zone of the adrenal cortex, belonging to the glucocorticosteroidal group of hormones. Clinical studies have shown that when humans are placed under stress, the hypothalamic-pituitary-adrenocortical axis is activated, leading to an increase in cortical secretion. However, the effect of splint is questionable by some researchers, and best way to perceive the effect of soft splints in patients with bruxism is by evaluating the stress levels. Materials and Methods A total of 20 individuals suffering from bruxism were selected from the Outpatient Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, Mysore. Saliva samples were collected before and after using the occlusal soft splints and subjected to enzyme-linked immunosorbent assay for determining the salivary cortisol levels. Results The collected data were subjected to appropriate descriptive statistics, paired sample t-test, and one sample t-test. The paired sample t-test shows that intragroup comparison of the mean cortisol level in the study group shows near significant values, which means there is a decrease in the salivary cortisol levels in patients after using soft occlusal splint, but statistically nonsignificant. Conclusion In the present study, it has been found that 70% of individuals after using the soft occlusal splint showed decreased cortisol levels.
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Affiliation(s)
- Pudi Sriharsha
- Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Anil Kumar Gujjari
- Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - M R Dhakshaini
- Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Abstract
Pediatric spasticity management requires special consideration because of continuous growth and underlying medical complications due to upper motor neuron disease. Early intervention, regular follow-up, and management of spasticity are critical to improve function and prevent musculoskeletal complications, functional deterioration, and the development of pain. Thorough history taking along with comprehensive medical evaluation and physical examination by practitioners with knowledge about spasticity are important clues for spasticity management in addition to thorough history taking and review of current medications. This article reviews the rationale of early intervention and continuum of care, basic physical examination, and therapeutic options for spasticity management and spasticity's aggravating factors.
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Prado-Mel E, Gil-López M, Navarro-Corrales MDC. Pregabalin-induced parkinsonism 72 hours after iodinated contrast administration. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Elena Prado-Mel
- Pharmacy Service; Andalussian Health Service; La Inmaculada Hospital; Almería Spain
| | - Marìa Gil-López
- Emergency Service; Andalussian Health Service; Nuestra Señora de la Merced Hospital; Osuna, Seville Spain
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Schneider C, Wissink T. Depression. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Hoashi Y, Okamoto S, Abe Y, Matsumoto T, Tanaka J, Yoshida Y, Imaizumi K, Mishima K, Akamatsu W, Okano H, Baba K. Generation of neural cells using iPSCs from sleep bruxism patients with 5-HT2A polymorphism. J Prosthodont Res 2017; 61:242-250. [PMID: 27916472 DOI: 10.1016/j.jpor.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Sleep bruxism (SB) is classified as a sleep-related movement disorder characterized by grinding and clenching of the teeth during sleep, which is responsible for a variety of clinical problems such as abnormal tooth attrition and fracture of teeth or roots. Little is known about the etiology of SB. Our previous study identified a genomic association of the serotonin 2A receptor (5-HT2A) single nucleotide polymorphism (SNP), rs6313 C>T, with SB, where the C allele carrier is associated with a 4.25-fold increased risk of SB. Based on this finding, the aim of this study was to generate of neural cells using SB patient-specific induced pluripotent stem cells (iPSCs). METHODS Two SB patients with C/C genotype of rs6313 and two controls with T/T genotype were screened by laboratory-based polysomnographic recordings and the TaqMan genotyping assay. Four lines of iPSCs, two from SB patients and two from controls, were established from peripheral blood mononuclear cells by introduction of reprogramming factors. We performed quality control assays on iPSCs using expression of markers for undifferentiated pluripotent cells, immunostaining for pluripotency markers, a three-germ layer assay, and karyotype analysis. The established iPSCs were differentiated into neurons using the neurosphere culture system. 5-HT2A gene expression in these neurons was evaluated by quantitative real-time PCR. RESULTS Patient-specific iPSCs were successfully differentiated into neurons expressing 5-HT2A. CONCLUSIONS This report is the first successful generation of neural cells using iPSCs from sleep bruxism patients with 5-HT2A polymorphism, which has the potential to elucidate the etiology and underlying mechanism of SB.
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Affiliation(s)
- Yurie Hoashi
- Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan
| | - Satoshi Okamoto
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuka Abe
- Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan
| | - Takashi Matsumoto
- Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan
| | - Junichi Tanaka
- Division of Pathology, Department of Oral Diagnostic Sciences, Showa University School of Dentistry, Tokyo, Japan
| | - Yuya Yoshida
- Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan
| | - Kent Imaizumi
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Mishima
- Division of Pathology, Department of Oral Diagnostic Sciences, Showa University School of Dentistry, Tokyo, Japan
| | - Wado Akamatsu
- Center for Genomic and Regenerative Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan.
| | - Kazuyoshi Baba
- Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan.
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Abstract
Temporomandibular joint disorder (TMD) is a broad pain disorder that refers to several conditions affecting the temporomandibular joint of the jaw and the muscles of mastication. As with most pain disorders, a high prevalence of depression and anxiety is associated with TMD. Research has shown that selective serotonin reuptake inhibitors (SSRIs), the first-line drug therapy for major depressive disorder, may not be suitable for TMD patients because SSRIs can induce teeth-grinding, otherwise known as bruxism. This is problematic because bruxism is believed to further exacerbate TMD. Therefore, the purpose of this literature review is to better understand the mechanism of SSRI-induced bruxism, as well as discuss alternative antidepressant options for treating depression and anxiety in patients with bruxism and TMD. Alternative classes of antidepressants reviewed include serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors. Findings indicate that dopamine agonists and buspirone are currently the most effective medications to treat the side effects of SSRI-induced bruxism, but results regarding the effectiveness of specific antidepressants that avoid bruxism altogether remain inconclusive.
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Parkinsonism secondary to duloxetine use: a case report. North Clin Istanb 2017; 2:243-246. [PMID: 28058376 PMCID: PMC5175115 DOI: 10.14744/nci.2015.63634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 09/08/2015] [Indexed: 11/20/2022] Open
Abstract
In literature, there are more than hundred cases of extrapyramidal symptoms (EPS) associated with selective serotonin reuptake intibitors (SSRI) whereas EPS case reports associated with serotonin noradrenaline reuptake inhibitors (SNRI) are in a relatively small number. A SNRI group drug duloxetine that is used for indication of major depression since 2004 is a double acting antidepressant that acts by blocking serotonin and noradrenaline reuptake. Side effects of duloxetine on extrapyramidal system are not expected due to low affinity to D2 receptors. In this case, report manifestations of parkinsonism developed in a patient who used duloxetine for major depression are presented. Since any duloxetine induced EPS case has not reported so far, we have thought that this case can contribute to the literature.
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Loonen AJM, Ivanova SA. Circuits Regulating Pleasure and Happiness-Mechanisms of Depression. Front Hum Neurosci 2016; 10:571. [PMID: 27891086 PMCID: PMC5102894 DOI: 10.3389/fnhum.2016.00571] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/27/2016] [Indexed: 01/22/2023] Open
Abstract
According to our model of the regulation of appetitive-searching vs. distress-avoiding behaviors, the motivation to display these essential conducts is regulated by two parallel cortico-striato-thalamo-cortical, re-entry circuits, including the core and the shell parts of the nucleus accumbens, respectively. An entire series of basal ganglia, running from the caudate nucleus on one side, to the centromedial amygdala on the other side, controls the intensity of these reward-seeking and misery-fleeing behaviors by stimulating the activity of the (pre)frontal and limbic cortices. Hyperactive motivation to display behavior that potentially results in reward induces feelings of hankering (relief leads to pleasure). Hyperactive motivation to exhibit behavior related to avoidance of misery results in dysphoria (relief leads to happiness). These two systems collaborate in a reciprocal fashion. In clinical depression, a mismatch exists between the activities of these two circuits: the balance is shifted to the misery-avoiding side. Five theories have been developed to explain the mechanism of depressive mood disorders, including the monoamine, biorhythm, neuro-endocrine, neuro-immune, and kindling/neuroplasticity theories. This paper describes these theories in relationship to the model (described above) of the regulation of reward-seeking vs. misery-avoiding behaviors. Chronic stress that leads to structural changes may induce the mismatch between the two systems. This mismatch leads to lack of pleasure, low energy, and indecisiveness, on one hand, and dysphoria, continuous worrying, and negative expectations on the other hand. The neuroplastic effects of monoamines, cortisol, and cytokines may mediate the induction of these structural alterations. Long-term exposure to stressful situations (particularly experienced during childhood) may lead to increased susceptibility for developing this condition. This hypothesis opens up the possibility of treating depression with psychotherapy. Genetic and other biological factors (toxic, infectious, or traumatic) may increase sensitivity to the induction of relevant neuroplastic changes. Reversal or compensation of these neuroplastic adjustments may explain the effects of biological therapies in treating depression.
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Affiliation(s)
- Anton J. M. Loonen
- Department of Pharmacy, University of GroningenGroningen, Netherlands
- GGZ WNB, Mental Health HospitalBergen op Zoom, Netherlands
| | - Svetlana A. Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of SciencesTomsk, Russia
- National Research Tomsk Polytechnic UniversityTomsk, Russia
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24
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Izci F, Zincir SB, Acar G, Semiz UB. Duloxetine and Venlafaxine Induced Akathisia: Two Case Reports. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20130114021519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Filiz Izci
- Erenkoy Neurological and Psychiatric Disorders Training and Research Hospital, Istanbul - Turkey
| | - Selma Bozkurt Zincir
- Erenkoy Neurological and Psychiatric Disorders Training and Research Hospital, Istanbul - Turkey
| | - Guler Acar
- Erenkoy Neurological and Psychiatric Disorders Training and Research Hospital, Istanbul - Turkey
| | - Umit Basar Semiz
- Erenkoy Neurological and Psychiatric Disorders Training and Research Hospital, Istanbul - Turkey
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25
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Abstract
Bupropion is an antidepressant that is effective in the treatment of major depressive disorders, smoking cessation, and sexual side effects of selective serotonin reuptake inhibitors. Acute dystonia is characterized by prolonged muscle contraction often represented by spasms of the head and neck muscles as well as occasional jaw clenching and temporomandibular joint syndrome. Although it is believed that dystonia is the result of an abnormality of the basal ganglia, its pathophysiology is still unclear. A few cases of dystonia resulting from bupropion have been reported in prior research papers. This case report discusses a patient who had a neck spasm painful enough to wake him up and dystonic distortion after taking only one dose of 75 mg bupropion. The patient was a young 34-year-old man with a diagnosis of obsessive-compulsive disorder treated with 60 mg fluoxetine. Bupropion was added to his medications because of sexual side effects caused by the fluoxetine. It seems that we must be careful to watch for dystonic symptoms when bupropion is mixed with other drugs that affect serotonin reuptake. Although dystonia is a rare side effect of bupropion, physicians should be aware of it and manage it if it occurs.
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Affiliation(s)
- Forouzan Elyasi
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Elham Mahtiyan
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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Abstract
Up to 90% of patients on chronic antipsychotic therapy will experience adverse neurologic side effects, with many of these effects attributable to the dopamine-blocking properties of these drugs. Even the newer, “atypical” antipsychotics are increasingly associated with neurologic complications. In the acute care setting, these medications have broad application beyond the management of psychiatric illness. Given the extent of their use, clinicians should be familiar with the spectrum of neurological syndromes that can develop. Some are common, such as akathisia, acute dystonic reaction, tardive dyskinesia, and drug-induced parkinsonism. Others, such as the life-threatening neuroleptic malignant syndrome, are rare yet must be recognized early to affect survival and improve outcome. This discussion highlights 2 idiosyncratic syndromes, acute dystonic reaction and neuroleptic malignant syndrome. The differential diagnosis for both syndromes and their management is discussed.
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Affiliation(s)
- Suzanne R. White
- Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan Regional Poison Control Center, Detroit, Michigan,
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28
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Abstract
Drug-induced movement disorders (DIMDs) pose a significant burden to patients, often resulting in nonadherence, disease relapse, and decreased quality of life. Dopamine-receptor blocking agents such as conventional antipsychotics (eg, haloperidol and chlorpromazine) and antiemetics (eg, metoclopramide and prochlorperazine) are most commonly implicated. DIMDs can be categorized by the onset of symptoms: acute reactions occurring hours to days after exposure, subacute DIMDs appearing within weeks, and tardive occurring months to years after drug exposure. The DIMDs of akathisia, tardive dyskinesia, dystonia, and parkinsonism are reviewed. Their epidemiology, mechanism, clinical presentation and differential diagnosis, risk factors, morbidity and mortality, and prevention and management are discussed. For many of these disorders, treatment inconsistently provides benefit, and therefore, primary prevention is essential. Clinicians and other healthcare professionals play a key role in the identification of patients with DIMDs, or those at risk, and in implementing prevention and treatment plans.
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Affiliation(s)
- Katherine L. Claxton
- Aurora Sinai Medical Center, Department of Pharmacy, 945 N State St, Milwaukee, WI 53233
| | - Jack J. Chen
- Schools of Medicine and Pharmacy, Loma Linda University, 11262 Campus St, West Hall, Loma Linda, CA 92350,
| | - David M. Swope
- Department of Neurology and School of Medicine, Loma Linda University, Loma Linda, CA 92350
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Simonsen AL, Danborg PB, Gøtzsche PC. Persistent sexual dysfunction after early exposure to SSRIs: Systematic review of animal studies. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 28:1-12. [DOI: 10.3233/jrs-160668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Escitalopram-Induced Progressive Cervical Dystonia. PSYCHOSOMATICS 2015; 56:572-5. [DOI: 10.1016/j.psym.2014.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/22/2022]
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Podurgiel SJ, Milligan MN, Yohn SE, Purcell LJ, Contreras-Mora HM, Correa M, Salamone JD. Fluoxetine Administration Exacerbates Oral Tremor and Striatal Dopamine Depletion in a Rodent Pharmacological Model of Parkinsonism. Neuropsychopharmacology 2015; 40:2240-7. [PMID: 25759301 PMCID: PMC4613615 DOI: 10.1038/npp.2015.69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/15/2015] [Accepted: 01/31/2015] [Indexed: 02/06/2023]
Abstract
The cardinal motor symptoms of Parkinson's disease (PD) include resting tremor, akinesia, bradykinesia, and rigidity, and these motor abnormalities can be modeled in rodents by administration of the VMAT-2 (type-2 vesicular monoamine transporter) inhibitor tetrabenazine (9,10-dimethoxy-3-(2-methylpropyl)-1,3,4,6,7, 11b hexahydrobenzo[a]quinolizin-2-one; TBZ). Depression is also commonly associated with PD, and clinical data indicate that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine ((±)-N-methyl-γ-[4-(trifluoromethyl)phenoxy]benzenepropanamine hydrochloride; FLX) are frequently used to treat depression in PD patients. The aim of the present study was to characterize the effect of FLX on the motor dysfunctions induced by a low dose of TBZ (0.75 mg/kg), and investigate the neural mechanisms involved. This low dose of TBZ was selected based on studies with rat models of depressive symptoms. In rats, coadministration of FLX (2.5, 5.0, and 10.0 mg/kg) increased TBZ-induced oral tremor (tremulous jaw movements), and decreased locomotor activity compared with administration of TBZ alone. Coadministration of the serotonin 5-HT2A/2C antagonist mianserin (2.5 and 5.0 mg/kg) attenuated the increase in oral tremor induced by coadministration of TBZ (0.75 mg/kg) with FLX (5.0 mg/kg). Consistent with these behavioral data, coadministration of TBZ and FLX decreased DA tissue levels in the rat ventrolateral neostriatum compared with TBZ alone, and coadministration of mianserin with TBZ and FLX attenuated this effect, increasing DA tissue levels compared with the TBZ/FLX condition. These data suggest that SSRI administration in PD patients may result in worsening of motor symptoms, at least in part, by exacerbating existing DA depletions through 5-HT2A/2C-mediated modulation of DA neurotransmission.
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Affiliation(s)
| | | | - Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Laura J Purcell
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Mercè Correa
- Àrea de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Hawthorne JM, Caley CF. Extrapyramidal Reactions Associated with Serotonergic Antidepressants. Ann Pharmacother 2015; 49:1136-52. [PMID: 26185277 DOI: 10.1177/1060028015594812] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Extrapyramidal reactions (EPRs) associated with serotonergic antidepressant treatments have been reported since 1958. These reactions can be distressing for patients and complicate treatment. Our objective was to complete a follow-up review of published EPR cases reported for serotonergic antidepressants. DATA SOURCES Published cases between January 1998 and May 2015 were collected through a medical literature search. Citation reference lists were also searched manually. STUDY SELECTION AND DATA EXTRACTION Identified cases were reviewed for patient age, gender, psychiatric diagnosis, dosage, time to reaction onset, concurrent medications, and EPR description. Cases were excluded when there was not a clear description, if descriptions were not consistent with accepted definitions, or if the written English was poor. We included cases of akathisia, dystonia, dyskinesia, parkinsonism, or mixed EPRs. Authors scored each case using the Naranjo adverse drug reaction probability scale. DATA SYNTHESIS We identified 86 published reports involving 91 patients; selective serotonin reuptake inhibitors were implicated in 80.2% of cases. All EPR types were reported: 17 akathisia cases, 18 dyskinesia cases, 27 dystonia cases, 19 parkinsonism cases, and 10 mixed EPR cases. EPRs typically occurred within 30 days of either treatment initiation or dose increase. Age, gender, antidepressant dosing, or concurrent antipsychotic treatment did not appear to broadly contribute to EPR risk. Naranjo scores ranged from 2 to 8. CONCLUSIONS Case reports associating serotonergic antidepressants with EPRs continue to be published. Practitioners are advised that monitoring for such is important. Rigorous research efforts are needed to better understand the clinical risk factors for these adverse drug reactions.
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Dyduch A, Załuska M. Depression in Parkinson's disease: the effectiveness and risk of pharmacotherapy. Clinical review. Psychogeriatrics 2015; 15:147-153. [PMID: 25377773 DOI: 10.1111/psyg.12078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 01/16/2023]
Abstract
Parkinson's disease (PD) is a neurological disease with a heterogeneous pattern of neurological symptoms and concomitant psychiatric syndromes. These syndromes are triggered by alterations to neurotransmission that are likely common for both neurological and psychiatric symptoms. Syndromes such as depression, anxiety, or cognitive impairment can precede motor symptoms of PD and delay its diagnosis. Recently, questions related to aetiological factors and treatment strategies of depression in PD have become a growing concern of PD researchers. This article describes the main features of depression in PD and presents current hypotheses on its aetiology and recommended treatment modes.
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Affiliation(s)
| | - Maria Załuska
- IV Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Amitai M, Chen A, Weizman A, Apter A. SSRI-Induced Activation Syndrome in Children and Adolescents—What Is Next? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40501-015-0034-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Damali Amiri N, Wijenaike N. Citalopram-induced hyponatraemia and parkinsonism: potentially fatal side-effects not to be missed. BMJ Case Rep 2014; 2014:bcr-2014-206575. [PMID: 25391825 DOI: 10.1136/bcr-2014-206575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The use of selective serotonin reuptake inhibitors (SSRIs), such as citalopram, is on the rise and, as such, clinicians must be vigilant of rare side-effects associated with this group of medications. We report the case of a 65-year-old man who presented to West Suffolk Hospital with a fall, confusion and movement abnormalities, and was found to have a serum sodium of 105 on admission. He was managed with hypertonic saline, dopamine agonists and intensive physiotherapy. Despite initially deteriorating neurologically, he made a remarkable recovery, and was discharged home at his pre-admission baseline. The learning points from this report are as follows: (1) regular monitoring of electrolytes on starting an SSRI (and similarly selective noradrenaline reuptake inhibitors-SNRIs) in SSRI/SNRIs naïve patients, (2) awareness of possible citalopram-induced parkinsonism and the potential benefits of dopamine agonists as one management strategy and (3) vigilant fluid/electrolyte monitoring in patients with profound hyponatraemia.
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Affiliation(s)
| | - Nishan Wijenaike
- Department of Diabetes & Endocrinology, West Suffolk Hospital, Bury St Edmunds, UK
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Howland RH. Atypical Antipsychotics Are Not All Alike: Side Effects and Risk Assessment. J Psychosoc Nurs Ment Health Serv 2014; 52:13-5. [DOI: 10.3928/02793695-20140820-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Nimber JS, Aggarwal A. Acute extrapyramidal syndrome induced by escitalopram: a case report. Psychopharmacology (Berl) 2014; 231:3813-4. [PMID: 25048289 DOI: 10.1007/s00213-014-3677-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/19/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Jagtar Singh Nimber
- Department of Psychiatry, Kalpana Chawla Government Medical College, Karnal, India
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Antidepressant Fluoxetine Modulates the In Vitro Inhibitory Activity of Buffalo Brain Cystatin: A Thermodynamic Study Using UV and Fluorescence Techniques. BIOTECHNOLOGY RESEARCH INTERNATIONAL 2014; 2014:319397. [PMID: 25170426 PMCID: PMC4131466 DOI: 10.1155/2014/319397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/29/2014] [Accepted: 05/06/2014] [Indexed: 11/18/2022]
Abstract
Cystatins constitute a superfamily of homologous proteins. The major role of cystatins is to regulate the unwanted proteolysis and to protect the organism against endogenous proteases released from lysosomes, invading microorganisms and parasites that use cysteine proteases to enter the body. Imbalance in regulation of proteolytic activity may lead to a wide range of human diseases. An enormous progress has been made in understanding of protein degradation process under normal and pathological conditions; infact proteases are now clearly viewed as important drug targets. Fluoxetine a selective serotonin reuptake inhibitor (SSRI) is an antidepressant. It is used to treat major depressive disorders. In the present study binding of fluoxetine to cystatin was studied by UV and fluorescence quenching technique. Intrinsic fluorescence of fluoxetine complexed with purified buffalo brain cystatin (BC) was measured by selectively exciting the tryptophan residues. Gradual quenching was observed on complex formation. When cystatin was added to fluoxetine solutions at a molar ratio of 1 : 0.5, it not only quenched more than half of its fluorescence but also reduced the activity of cystatin. Stern-Volmer plots obtained from experiments carried out at 25(°)C showed the quenching of fluorescence to be a collisional phenomenon. Our results suggest the prime binding site for fluoxetine on BC to be at or near tryptophan residues. Fluoxetine quenched the fluorescence by a static process, which specifically indicates the formation of a complex.
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Murakami T, Masaki C, Takahashi H, Makino M, Mukaibo T, Kondo Y, Nakamoto T, Hosokawa R. Sleep bruxism is affected by peripheral benzodiazepine receptor gene polymorphisms. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2014. [DOI: 10.1007/s12548-013-0101-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Abstract
OBJECTIVE To describe a case of orofacial dyskinesia in a patient treated with levofloxacin for acute diverticulitis. CASE SUMMARY A 77-year-old woman with mild renal insufficiency was admitted with acute diverticulitis. She was initiated on levofloxacin 500 mg IV daily and metronidazole 500 mg IV every 8 hours. On day 4 of treatment, she experienced involuntary, rhythmic facial grimacing accompanied by periodic cervical muscular contractures. Her speech became dysarthric, interrupted by uncontrolled facial and tongue movements, all findings consistent with orofacial dyskinesia. Antibiotics were discontinued, and symptoms resolved after administration of diphenhydramine and lorazepam IV. DISCUSSION Fluoroquinolone-associated central nervous system (CNS) toxicities are infrequently observed. They are most commonly associated with ciprofloxacin and are thought to be related to inhibition of γ-aminobutyric acid receptors and activation of N-methyl-d-aspartate receptors. Orofacial dyskinesia has previously been reported primarily with second-generation fluoroquinolones, with only a single case report implicating a third-generation fluoroquinolone. To our knowledge, we report the second case of orofacial dyskinesia with a third-generation fluoroquinolone, the first such case associated with levofloxacin. The orofacial dyskinesia experienced in this case was categorized as probably related to levofloxacin, as assessed by the Naranjo adverse drug reaction probability assessment tool. Contributing factors likely included age and renal function. CONCLUSIONS Although rare, CNS toxicities such as orofacial dyskinesia have been reported with levofloxacin. Patients on fluoroquinolones of advanced age and with renal insufficiency should be monitored closely for such toxicities.
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Bonuccelli U, Meco G, Fabbrini G, Tessitore A, Pierantozzi M, Stocchi F, Ceravolo R, Caltagirone C, Silvestrini M, Morgante F, Ruggieri S, Avanzino L, Guadagna M, Dell'Agnello G, Rossi A, Spezia R, Mancini M. A non-comparative assessment of tolerability and efficacy of duloxetine in the treatment of depressed patients with Parkinson's disease. Expert Opin Pharmacother 2013; 13:2269-80. [PMID: 23067321 DOI: 10.1517/14656566.2012.736490] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Depression is a comorbidity affecting quality of life (QoL) in patients with Parkinson's disease (PD) and requires appropriate treatment. This study evaluated the tolerability, safety, and efficacy of duloxetine 60 mg once daily for 12 weeks in PD patients with major depressive disorder (MDD). RESEARCH AND DESIGN METHODS Non-comparative, open-label, multi-center study. MAIN OUTCOME MEASURES Tolerability was evaluated by discontinuation rate (acceptable if ≤ 19%) due to treatment-emergent adverse events (TEAEs) and motor symptoms (UPDRS). Safety measures were TEAEs, the UKU side effect rating scale, vital signs, weight, laboratory tests, and ECG. Efficacy measures included HAMD-17, BDI, CGI-S, PGI-I, and pain VAS. QoL was measured by PDQ-39. RESULTS Of the 151 patients enrolled, 8.6% (95% upper CI: 13.3%) discontinued the study due to TEAEs. Worsening in PD-related tremor and rigidity was not observed, activities of daily living significantly improved and UKU subscales progressively decreased. Clinically significant abnormalities in laboratory findings were limited to four cases of hypercholesterolemia and one increase of total bilirubin, CPK, and fasting glucose. Blood pressure, weight, and ECG did not change from baseline. HAMD-17 and PDQ-39 total score and individual domains, BDI, CGI-S, and PGI-I total scores significantly improved. CONCLUSIONS Duloxetine seems well tolerated and likely effective in the treatment of depression associated with PD, with no detrimental effects in PD signs and symptoms.
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Kaufman KR, Podolsky D, Greenman D, Madraswala R. Antidepressant-selective gynecomastia. Ann Pharmacother 2013; 47:e6. [PMID: 23324513 DOI: 10.1345/aph.1r491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe what we believe is the first reported case of synergistic gynecomastia during treatment of depressive and anxiety disorders when sertraline was added to a stable medication regimen including duloxetine, rosuvastatin, and amlodipine. CASE SUMMARY A 67-year-old male with major depression, dysthymia, obsessive-compulsive disorder, social anxiety, hypertension, diabetes, and hyperlipidemia presented with new-onset gynecomastia and breast tenderness. Mammography revealed bilateral gynecomastia (fibroglandular tissue posterior to the nipples bilaterally) without suspicious mass, calcification, or other abnormalities. These new symptoms developed after sertraline was added to his stable medication regimen (duloxetine, alprazolam, rosuvastatin, metoprolol, amlodipine, hydrochlorothiazide/triamterene, metformin, and sitagliptin). These symptoms were dose-dependent, with gynecomastia and breast tenderness more severe as sertraline was titrated from 25 mg/day to 50 mg/day and then to 75 mg/day. When sertraline was discontinued, gynecomastia and breast tenderness rapidly resolved. DISCUSSION Mammoplasia and gynecomastia are associated with altered dopamine neurotransmission and/or perturbations in sexual hormones. These adverse effects may be medication induced. Selective serotonin reuptake inhibitors (sertraline), serotonin-norepinephrine reuptake inhibitors (duloxetine), rosuvastatin, and amlodipine have been reported to cause these adverse effects. This case was unique, since the patient had been on both sertraline and duloxetine previously as independent psychotropics without the development of gynecomastia. In the context of an additive drug adverse effect, the probability of sertraline as the precipitant drug was determined by both the Naranjo probability scale and the Horn drug interaction probability scale as probable. CONCLUSIONS Gynecomastia is associated with antidepressants and other medications but is rarely addressed. Gynecomastia may be antidepressant selective or may be the result of additive adverse effects. Clinicians are advised to question patients regarding this potential adverse effect. Further education of clinicians is indicated.
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Affiliation(s)
- Kenneth R Kaufman
- Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), New Brunswick, NJ, USA.
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Abstract
Background: This is a report of a 66-year-old male with Parkinson's disease (PD), depression and anxiety who developed tardive dyskinesia (TD) while on fluoxetine.Methods: The patient underwent psychiatric, neurological and neuroimaging examination.Results: The patient's neuroimaging examination was normal, his psychiatric assessment revealed depression and anxiety, and his neurological evaluation diagnosed only mild PD. The patient's TD resolved when fluoxetine was discontinued and recurred upon re-exposure.Conclusion: This case shows that fluoxetine as monotherapy can be associated with TD especially in patients with concomitant PD. Clinicians must be aware of this side-effect and monitor for features of TD due to antidepressants that are often used to treat comorbid depression in patients with PD.
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Affiliation(s)
- Deshandra M Raidoo
- Sioux Falls Veterans Affairs Health Care System, Sioux Falls, South Dakota, USA
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Nelson JC, Thase ME, Trivedi MH, Fava M, Han J, Van Tran Q, Pikalov A, Qi Y, Carlson BX, Marcus RN, Berman RM. Safety and Tolerability of Adjunctive Aripiprazole in Major Depressive Disorder: A Pooled Post Hoc Analysis (studies CN138-139 and CN138-163). PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:344-52. [PMID: 20098527 DOI: 10.4088/pcc.08m00744gre] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 01/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the safety and tolerability of aripiprazole adjunctive to standard antidepressant therapy (ADT) for patients with major depressive disorder (DSM-IV-TR criteria). METHOD Data from 2 identical studies of aripiprazole augmentation (8 weeks of prospective ADT treatment followed by 6 weeks of randomized double-blind adjunctive treatment) were pooled. The incidence of treatment-emergent adverse events (TEAEs) and weight, electrocardiogram (ECG), and laboratory measurements were assessed during the 6-week phase, including time course, severity, resolution, and predictors. The studies were conducted from June 2004 to April 2006 and September 2004 to December 2006. RESULTS The safety analysis included 737 outpatients (aripiprazole, n = 371; placebo, n = 366). The majority of patients completed the trials (aripiprazole, 86%; placebo, 88%). Common TEAEs (≥ 5% and twice the placebo rate) with aripiprazole were akathisia (25%), restlessness (12%), insomnia (8%), fatigue (8%), blurred vision (6%), and constipation (5%). Most TEAEs were of mild to moderate severity (aripiprazole, 89%; placebo, 95%). TEAE rates in the aripiprazole and placebo groups were not affected by ADT, age, or gender. Discontinuation due to TEAEs was low (aripiprazole, 3%; placebo, 1%). Mean weight change was higher with aripiprazole versus placebo (1.73 kg vs 0.38 kg, P < .001). At endpoint, clinical laboratory parameters, vital signs, and ECG indices (including QT(c) interval) were similar between groups. Akathisia with aripiprazole generally occurred in the first 3 weeks (76%), was of mild to moderate severity (92%), and led to discontinuation in 3 patients (0.8%). Within the aripiprazole group, age (18-40 years) was the only positive predictor for akathisia. CONCLUSIONS In this short-term post hoc analysis, aripiprazole as augmentation to ADT demonstrated a safety and tolerability profile similar to that in monotherapy studies in other psychiatric populations. Controlled long-term safety and efficacy data of aripiprazole as adjunctive to ADT are warranted. TRIAL REGISTRATION clinicaltrials.gov Identifiers: NCT00095823 (CN138-139) and NCT00095758 (CN138-163).
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Affiliation(s)
- J Craig Nelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
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Oulis P, Konstantakopoulos G, Nathanailidis E, Tsiamoura M, Kollias K. Low-dose aripiprazole in the treatment of selective serotonin reuptake inhibitors-induced orofacial and buccal dystonia. Psychiatry Clin Neurosci 2012; 66:462-3. [PMID: 22834670 DOI: 10.1111/j.1440-1819.2012.02363.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cirillo DJ, Wallace RB. Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. BMC Geriatr 2012; 12:39. [PMID: 22834914 PMCID: PMC3433378 DOI: 10.1186/1471-2318-12-39] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 07/12/2012] [Indexed: 11/10/2022] Open
Abstract
Background Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders. Methods Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation. Results The prevalence of RLS among U.S. elders born before 1947 was 10.6%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46). Conclusions RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.
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Affiliation(s)
- Dominic J Cirillo
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Benninghoff J, van der Ven A, Schloesser RJ, Moessner R, Möller HJ, Rujescu D. The complex role of the serotonin transporter in adult neurogenesis and neuroplasticity. A critical review. World J Biol Psychiatry 2012; 13:240-7. [PMID: 22409535 DOI: 10.3109/15622975.2011.640941] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Studies on the serotonin transporter (SERT) with regard to neurogenesis and neuroplastic effects on the adult brain are scarce. This is intriguing since neurogenesis is believed to play a decisive role in modulating the effect of selective serotonin reuptake inhibitors (SSRI), which are targeting SERT. METHODS Therefore, we reviewed the current scientific literature about the influence of serotonin on neurogenesis with particular emphasis on SERT in various settings, both in vivo and in vitro. RESULTS Experiments using SERT KO (knock-out) animal models showed that SERT does not directly or indirectly influence neurogenesis in vitro, whereas compensatory mechanism seem to participate in vivo. CONCLUSION At least with regard to adult neural stem cells, the impact of serotonin (5-HT) on neuroplasticity and neurogenesis is not due to SERT-mediated effcts. Instead, serotonergic fine-tuning may be exerted by a number of other different mechanisms including endogenous production of 5-HT in adult neural stem cells, uptake of 5-HT into adult neural stem cells by other monoamine transporters, and actions of the 5-HT1A receptors present on these cells.
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Affiliation(s)
- Jens Benninghoff
- Department of Psychiatry, LMU-University of Munich, Munich, Germany.
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