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Mohamed AN, Michel MA, McFarlane SI. Gabapentin-Induced Myoclonus in a Patient With Chronic Kidney Disease. Cureus 2023; 15:e47351. [PMID: 38021980 PMCID: PMC10657337 DOI: 10.7759/cureus.47351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Gabapentin contains a cyclohexyl group and is a form of gamma-aminobutyric acid (GABA). Despite its name, gabapentin does not affect the inhibitory neurotransmitter GABA or its receptors. Instead, it acts as a ligand, binding strongly to the α2δ (Ca) channel subunit and interfering with its regulatory function and the release of excitatory neurotransmitters. Gabapentin is approved by the FDA for treating seizure disorders and neuropathic pain, except for trigeminal neuralgia. However, it is frequently used off-label to treat other pain conditions and psychological disorders, such as anxiety. Unlike other drugs, gabapentin is not metabolized in the liver and is solely excreted by the kidneys. Therefore, it is crucial to adjust the dosage in patients with renal insufficiency to avoid severe adverse effects. In this case report, we present a patient with chronic renal impairment who experienced devastating myoclonic jerky movements shortly after increasing his gabapentin dose.
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Affiliation(s)
- Ammar N Mohamed
- Internal Medicine, State University of New York Downstate Medical Center University Hospital, Brooklyn, USA
- Internal Medicine, Kings County Hospital Center, Brooklyn, USA
- Internal Medicine, Veterans Affairs Medical Center, Brooklyn, USA
| | | | - Samy I McFarlane
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
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Rissardo JP, Medeiros Araujo de Matos U, Fornari Caprara AL. Gabapentin-Associated Movement Disorders: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:52. [PMID: 37755242 PMCID: PMC10536490 DOI: 10.3390/medicines10090052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Gabapentin (GBP)-induced movement disorders (MDs) are under-recognized adverse drug reactions. They are commonly not discussed with patients, and their sudden occurrence can lead to misdiagnosis. This literature review aims to evaluate the clinical-epidemiological profile, pathological mechanisms, and management of GBP-associated MD. METHODS Two reviewers identified and assessed relevant reports in six databases without language restriction between 1990 and 2023. RESULTS A total of 99 reports of 204 individuals who developed a MD associated with GBP were identified. The MDs encountered were 135 myoclonus, 22 dyskinesias, 7 dystonia, 3 akathisia, 3 stutterings, 1 myokymia, and 1 parkinsonism. The mean and median ages were 54.54 (SD: 17.79) and 57 years (age range: 10-89), respectively. Subjects were predominantly male (53.57%). The mean and median doses of GBP when the MD occurred were 1324.66 (SD: 1117.66) and 1033 mg/daily (GBP dose range: 100-9600), respectively. The mean time from GBP-onset to GBP-associated MD was 4.58 weeks (SD: 8.08). The mean recovery time after MD treatment was 4.17 days (SD: 4.87). The MD management involved GBP discontinuation. A total of 82.5% of the individuals had a full recovery in the follow-up period. CONCLUSIONS Myoclonus (GRADE A) and dyskinesia (GRADE C) were the most common movement disorders associated with GBP.
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Afif S, Rehan ST, ul Hussain H, Islam MS. Low-intensity focused ultrasound, a novel approach to epilepsy treatment in developing countries. Brain Behav 2023; 13:e2852. [PMID: 36542525 PMCID: PMC9847596 DOI: 10.1002/brb3.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 80% of patients with epilepsy reside in poor resource settings. Despite the continued advancements and development of new treatment approaches, epilepsy remains a major health problem in developing countries. Consistent findings of epidemiologic studies reflect that both prevalence and treatment gap are higher in the developing world. The objective of this short review was to evaluate current treatment options and low-intensity, pulsed-focused ultrasound (FUS) as a potential new treatment option for epilepsy. Although some of the patients could be candidates for surgery, many factors, including poor health-care infrastructure, socioeconomic status, risks and complications associated with the surgery, and patients' preferences and attitudes toward the surgical procedure, limit the adherence to get surgical therapies. Low-intensity FUS, a novel and noninvasive therapeutic approach, has the potential to be approved by regulatory bodies and added to the list of standard treatment options for epilepsy. Improved understanding of epilepsy's prevalence and incidence in developing worlds, identification of potential new therapeutic options, and their evaluation through continuous studies and clinical trials are needed to reduce the burden of epilepsy and the treatment gap.
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Affiliation(s)
- Sadaf Afif
- Touro College of Osteopathic MedicineNew YorkNew YorkUSA
| | | | - Hassan ul Hussain
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Md. Saiful Islam
- Department of Public Health and InformaticsJahangirnagar UniversitySavar DhakaBangladesh
- Centre for Advanced Research Excellence in Public HealthSavar DhakaBangladesh
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Zhou DJ, Pavuluri S, Snehal I, Schmidt CM, Situ-Kcomt M, Taraschenko O. Movement disorders associated with antiseizure medications: A systematic review. Epilepsy Behav 2022; 131:108693. [PMID: 35483204 PMCID: PMC9596228 DOI: 10.1016/j.yebeh.2022.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
New-onset movement disorders have been frequently reported in association with the use of antiseizure medications (ASMs). The frequency of specific motor manifestations and the spectrum of their semiology for various ASMs have not been well characterized. We carried out a systematic review of literature and conducted a search on CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus from inception to April 2021. We compiled the data for all currently available ASMs using the conventional terminology of movement disorders. Among 5123 manuscripts identified by the search, 437 met the inclusion criteria. The largest number of reports of abnormal movements were in association with phenobarbital, valproic acid, lacosamide, and perampanel, and predominantly included tremor and ataxia. The majority of attempted interventions for all agents were discontinuation of the offending drug or dose reduction which led to the resolution of symptoms in most patients. Familiarity with the movement disorder phenomenology previously encountered in relation with specific ASMs facilitates early recognition of adverse effects and timely institution of targeted interventions.
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Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Spriha Pavuluri
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Isha Snehal
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cynthia M Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, United States
| | - Miguel Situ-Kcomt
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
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Frias JM, Michou J, Fadda A. Chlorphenamine for prolonged drug‐induced extrapyramidal side effects in a dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Joao Miguel Frias
- Neurology and NeurosurgeryRoyal Veterinary College ‐ Hawkshead CampusHatfieldUK
- Neurology and NeurosurgeryLumbry Park Veterinary SpecialistsAltonUK
| | - Joanne Michou
- AnaesthesiaLumbry Park Veterinary SpecialistsAltonUK
| | - Angela Fadda
- Neurology and NeurosurgeryLumbry Park Veterinary SpecialistsAltonUK
- Neurology and NeurosurgeryLangford Veterinary ServicesBristolUK
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Desai A, Kherallah Y, Szabo C, Marawar R. Gabapentin or pregabalin induced myoclonus: A case series and literature review. J Clin Neurosci 2019; 61:225-234. [DOI: 10.1016/j.jocn.2018.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 01/26/2023]
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Kim JB, Jung JM, Park MH, Lee EJ, Kwon DY. Negative myoclonus induced by gabapentin and pregabalin: A case series and systematic literature review. J Neurol Sci 2017; 382:36-39. [PMID: 29111014 DOI: 10.1016/j.jns.2017.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Negative myoclonus is a jerky, brief, and sudden interruption of voluntary muscle contraction. Although gabapentin and pregabalin have been reported to induce positive myoclonus in some patients with impaired renal function, there are only a few studies describing pregabalin- or gabapentin-induced negative myoclonus. This study reviewed patients who had developed pregabalin- or gabapentin-induced negative myoclonus. METHODS We collected the patients with negative myoclonus who were referred to the department of neurology at a university-affiliated hospital and selected pregabalin- or gabapentin-induced negative myoclonus. Then reviewed the literature with respect to pregabalin- or gabapentin-induced negative myoclonus. RESULTS A total of 77 patients with negative myoclonus were reviewed. Among them, 21 neuropathic pain patients who were prescribed and developed negative myoclonus induced by pregabalin (9 cases) or gabapentin (12 cases). To prove causality of the drug, probable and certain level of category according to the WHO-UMC criteria were recruited. Of the 21 patients, 3 had impaired renal function, while 18 had normal renal function. Review of the literature identified 7 further cases (6 had normal renal function) with pregabalin- or gabapentin-induced negative myoclonus. CONCLUSION Pregabalin- and gabapentin-induced negative myoclonus can develop even in patients with normal renal function. Physicians should keep in mind the possibility of patients developing negative myoclonus under treatment of pregabalin or gabapentin even in short period of time and with low dosage, and in the normal range of renal function. Further prospective study investigating incidence and risk factors is warranted.
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Affiliation(s)
- Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Moon-Ho Park
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Eun Ju Lee
- Medical Library, Korea University, Seoul, South Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
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Lalonde R, Strazielle C. Brain regions and genes affecting myoclonus in animals. Neurosci Res 2012; 74:69-79. [PMID: 22824643 DOI: 10.1016/j.neures.2012.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/02/2012] [Accepted: 07/12/2012] [Indexed: 01/26/2023]
Abstract
Myoclonus is defined as large-amplitude rhythmic movements. Brain regions underlying myoclonic jerks include brainstem, cerebellum, and cortex. Gamma-aminobutyric acid (GABA) appears to be the main neurotransmitter involved in myoclonus, possibly interacting with biogenic amines, opiates, acetylcholine, and glycine. Myoclonic jumping is a specific subtype seen in rodents, comprising rearing and hopping continuously against a wall. Myoclonic jumping can be seen in normal mouse strains, possibly as a result of simply being put inside a cage. Like other types, it is also triggered by changes in GABA, 5HT, and dopamine neurotransmission. Implicated brain regions include hippocampus and dorsal striatum, possibly with respect to D(1) dopamine, NMDA, and δ opioid receptors. There is reason to suspect that myoclonic jumping is underreported due to insufficient observations into mouse cages.
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Affiliation(s)
- R Lalonde
- Université de Rouen, UFR des Sciences Humaines et Sociales, Laboratoire de Psychologie et Neurosciences: Intégration COgnitive du NEurone à la Société (ICONES), 76821 Mont Saint-Aignan Cedex, France.
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Rosen JB, Milstein MJ, Haut SR. Olanzapine-associated myoclonus. Epilepsy Res 2012; 98:247-50. [DOI: 10.1016/j.eplepsyres.2011.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 07/19/2011] [Accepted: 07/31/2011] [Indexed: 10/14/2022]
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