Central Nervous System Irritability Research Articles

Copper and lead as environmental pollutant and their elemental toxicity – a review

Pollutants are substances in the environment with potential objectionable effects leading to impairment of the welfare of environment, interfering with the quality of life that may eventually result to the organisms being affected. The aim here was to give summary of the review of the toxicity of Copper and Zinc as pollutants in the environment, be it air, water or soil, which may be poisonous and will cause harm to living organisms in the polluted environment. The elemental concentration of sediment therefore and its bioavailability not only depends on anthropogenic and lithogenic sources, but also on organic matter, physical (textural) characteristics as well as mineralogical composition and depositional environment of sediments. Copper causes toxicity and hazards in flora, fauna and human beings. It causes a disease called ‘Wilson’s disease. Excessive exposure to Cu may cause haemolysis, hepatotoxic and nephrotoxic effects. Mucosal irritation, corrosion, widespread capillary damage, hepatic and renal damage and central nervous system irritation are some of the dysfunctions consequent to Cu exposure. Among the various means through which lead toxicity occurs are; the ionic mechanism and the oxidative stress. Several studies indicated that oxidative stress in living cells is caused by the imbalance between the production of free radicals and the generation of antioxidants to detoxify the relative intermediates or to repair the resulting damage.

Does pharmacological treatment of withdrawal symptoms improve the sleep patterns in infants with neonatal abstinence syndrome (NAS)

Background: Infants with NAS may have disturbed sleep, and increased movement reflecting central nervous system irritability. However, sleep pattern in such infants following control of withdrawal symptoms with methadone hasn’t been quantitatively analyzed. We hypothesized that successful treatment of withdrawal symptoms with methadone would also improve the sleep patterns in infants with NAS. Persistent disordered sleep in the neonatal period if persists even after pharmacological control of withdrawal symptoms may potentially lead to adverse childhood neurodevelopmental outcome. Objective: To characterize sleep-wake states using Actigraphy (activity-based sleep-wake …

Amplitude-integrated EEG use in neonatal abstinence syndrome: a pilot study

Objective: Though central nervous system irritability is a well-established consequence of neonatal drug withdrawal, brain function in infants with neonatal abstinence syndrome (NAS) is not well understood. Amplitude-integrated electroencephalography (aEEG) is a bedside tool used for monitoring brain activity and seizures. We describe the prevalence of abnormal aEEG background patterns in infants with NAS.Methods: In this pilot, observational study primary outcomes were aEEG findings, Finnegan scores, and length of hospital stay in NAS patients. Subjects underwent an initial aEEG and a repeat study following pharmacologic treatment. Two independent reviewers analyzed aEEGs post discharge.Results: Six out of nine infants had abnormal aEEGs demonstrating lack of sleep-wake cycling (SWC) (50%), discontinuity (41.7%), and low voltage (8.3%). Seizures were not detected. NAS scores were lower for infants with continuous aEEGs versus those whose aEEGs were not continuous (5.83 versus 9.17; p = .054). Length of stay was 7.8 ± 4.4 days in infants with continuous aEEGs versus 26 ± 10.5 days in infants without continuous aEEGs (p = .003).Conclusions: Infants exposed to opioids in utero are at increased risk for discontinuity and abnormal SWC detectable on aEEG. Infants with abnormal aEEGs are more likely to have higher NAS scores, require pharmacologic treatment and have longer lengths of stay.

Hypocalcemia in an 11Year Old Child: A Difficult Case to Treat.

Hypocalcemia is a laboratory and clinical abnormality that is observed especially in neonates and paediatric patients. Laboratory hypocalcaemia is often asymptomatic but it can manifest as central nervous system irritability, paraesthesia, tetany (i.e. contraction of hands, arms, feet, larynx, bronchioles), seizures, and even psychiatric changes in children. Cardiac function may also be impaired because of poor muscle contractility. We report a unique case of an eleven year old male child who presented with chronic kidney disease associated with severe hypocalcemia, tonic-clonic seizures, hypovitaminosis D but normal electroencephalogram and electrocardiography. The child required prolonged intravenous calcium gluconate therapy to correct his ionised calcium levels.

CDC Grand Rounds: Public Health Strategies to Prevent Neonatal Abstinence Syndrome.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that most commonly occurs in infants after in utero exposure to opioids, although other substances have also been associated with the syndrome (1). NAS usually appears within 48-72 hours of birth with a constellation of clinical signs, including central nervous system irritability (e.g., tremors), gastrointestinal dysfunction (e.g., feeding difficulties), and temperature instability (1) (Box 1). Opioid exposure during pregnancy might result from clinician-approved use of prescription opioids for pain relief; misuse or abuse of prescription opioids; illicit use (e.g., heroin); or medication-assisted treatment (MAT) of opioid use disorder (2) (Box 2).

Iatrogenic Withdrawal Syndromes in Children: A Review of Sedative and Analgesic Weaning

Iatrogenic withdrawal syndromes develop in children exposed to prolonged sedative and analgesic medications. Signs of withdrawal include central nervous system irritability, gastrointestinal dysfunction, and autonomic dysfunction. The most important steps to the safe management of sedative and analgesic weaning in children are the early identification of the risk of withdrawal, use of a validated withdrawal assessment scale, use of nonpharmacologic interventions, and administration of medication for weaning, if indicated. This article reviews the physiologic mechanisms of opioid tolerance and withdrawal, validated pediatric withdrawal scales, and safe management of iatrogenic withdrawal syndromes. Figures illustrate cellular responses to acute and chronic exposure to opioids. A suggested algorithm for the safe and rapid weaning of sedative and analgesic medications, using the best available evidence, is discussed. Key words: analgesic weaning, opioid tolerance, pediatric withdrawal, sedation weaning, weaning algorithm for children

Iatrogenic Withdrawal Syndromes in Children: A Review of Sedative and Analgesic Weaning

Iatrogenic withdrawal syndromes develop in children exposed to prolonged sedative and analgesic medications. Signs of withdrawal include central nervous system irritability, gastrointestinal dysfunction, and autonomic dysfunction. The most important steps to the safe management of sedative and analgesic weaning in children are the early identification of the risk of withdrawal, use of a validated withdrawal assessment scale, use of nonpharmacologic interventions, and administration of medication for weaning, if indicated. This article reviews the physiologic mechanisms of opioid tolerance and withdrawal, validated pediatric withdrawal scales, and safe management of iatrogenic withdrawal syndromes. Figures illustrate cellular responses to acute and chronic exposure to opioids. A suggested algorithm for the safe and rapid weaning of sedative and analgesic medications, using the best available evidence, is discussed. Key words: analgesic weaning, opioid tolerance, pediatric withdrawal, sedation weaning, weaning algorithm for children

Incidence of Neonatal Abstinence Syndrome - 28 States, 1999-2013.

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000-2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999-2013. Among 28 states with publicly available data in HCUP during 1999-2013, the overall NAS incidence increased 300%, from 1.5 per 1,000 hospital births in 1999, to 6.0 per 1,000 hospital births in 2013. During the study period, significant increases in NAS incidence occurred in 25 of 27 states with at least 3 years of data, with annual incidence rate changes ranging from 0.05 (Hawaii) to 3.6 (Vermont) per 1,000 births. In 2013, NAS incidence ranged from 0.7 cases per 1,000 hospital births (Hawaii) to 33.4 cases per 1,000 hospital births (West Virginia). The findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy, as well as decrease the incidence of NAS.

Use of Ertapenem at an Academic Medical Center

Background Ertapenem is a once-daily, broad-spectrum antibiotic convenient for outpatient parenteral antimicrobial therapy (OPAT). The primary focus of our study was to assess the efficacy and safety of ertapenem for OPAT. Methods Data were retrospectively collected from patients receiving ertapenem for a 24-month period. Patient characteristics, therapeutic indication, and microbiology were reviewed. Outcome measures included clinical and microbiologic success, improvement, or failure and the safety profile of ertapenem. Results Two hundred ninety-two consecutive patients received ertapenem, and 202 met inclusion criteria for ertapenem OPAT. Patients received a median of 29 days for a range of indications, most commonly intra-abdominal (32.2%), osteomyelitis (29.2%), and skin and soft tissue infection (14.4%). One hundred seventeen OPAT patients had a polymicrobial infection. One hundred eighty-six patients were evaluable for clinical outcomes. Clinical success occurred in 92% of patients: clinical improvement was achieved in 69%, and clinical cure was achieved in 23% of patients. Clinical failure occurred in 15 patients (8.1%). Ertapenem was well tolerated with only 25 (13.4%) of 186 patients experiencing an adverse event. The most common adverse drug events were altered mental status in 7 patients and 2 additional patients with seizures in patients with creatinine clearances of less than 50 mL/min, and increased liver function tests (n = 4). Conclusions Ertapenem is frequently used for OPAT because it is convenient, well tolerated, and clinically effective for abdominal, skin and soft tissue, and bone infections. It has an excellent safety profile, but central nervous system irritability in patients with diminished renal function may warrant closer attention.

Feverish Agitation Unveiling a Poly Poisoning in Young Children

The use of plants is widespread with traditional Moroccan medicine occasionally resulting in poisoning that can be sometimes be fatal, especially in children. The toxicity of medicinal plants and their chemical interactions are mostly unknown by many who use these topical/oral mixtures. We report the case of 4 year old boy, hospitalized in the department of Infectious Diseases P1 at the Children's Hospital of Rabat for 'feverish agitation' (fever and central nervous system irritability) after inhalation of Peganum harmala, ingestion of Chenopodium and nasal application of cade oil. The laboratory tests concluded renal and hepatic failure. The clinical condition improved after 36 hours, with renal and hepatic failure resolving after 3 to 6 days.

Drogenentzug beim Neugeborenen – klinische und soziodemografische Daten von 49 Neugeborenen drogenabhängiger Mütter: Was kann und soll getan werden?

Infants of drug abusing mothers are at high risk to suffer from neonatal abstinence syndrome (NAS). Depending on the drug signs of neonatal withdrawal vary but mainly include central nervous system irritability. NAS causes long duration of hospital stay. Severe withdrawal signs are seen in infants exposed to methadone, infants exposed to other opioids like heroin or buprenorphine have been shown to be less symptomatic. Between the years 1997 and 2003 following the border opening there was a dramatic increase in drug exposed newborns seen in the area of Leipzig (East Germany). In a retrospective study maternal and infant characteristics, severity of symptoms, duration of withdrawal and hospital stay, duration and kind of treatment as well as modalities for release from hospital were analyzed. From 1997 to 2003 49 drug exposed newborns were admitted to our neonatal care unit. There was an increase of the number of affected infants within these years ( ). Maternal drug abuse (n=48) included mainly methadone (n=33), in second line heroine and benzodiazepines, in a few cases also cocaine and cannabinoides. 3 mothers received substitution therapy with buprenorphine. Additional drug use to substitution therapy was seen in 15 mothers. Drugs of abuse were detected in infant urine specimen (36/48). 35 of exposed newborns showed signs of NAS (incidence of NAS 71%). For evaluation of withdrawal signs and conduction of therapy the Finnegan score was used. As first line pharmacological treatment phenobarbitone was administered (n=42), secondary morphine was used (n=14, treatment failure 33%). Mean duration of hospital stay was 21 days. Mean duration of pharmacological treatment was 14 days with longer duration for methadone exposed infants vs. non-methadone exposed infants (16 vs. 10 days). Hospital stay was longer for non-methadone exposed infants. Maternal intake of more than 20 mg methadone per day vs. up to 20 mg per day caused longer duration of hospital stay (28 vs. 20 days, p=0,015). Long duration of hospital stay and pharmacological treatment call for optimised principal guide lines for diagnosis, treatment and long term follow-up. The results also underline the need for further research for an effective pharmacological treatment.

Anesthetic Properties of Some Fluorinated Oxolanes and Oxetanes

The search for new potent inhaled anesthetics has slowed, in large part because of the excellence of the two most recent additions, desflurane and sevoflurane. Nonetheless, neither desflurane nor sevoflurane are ideal anesthetics, desflurane causing cardiorespiratory stimulation, and sevoflurane having a slower (albeit rapid) recovery from anesthesia. Sevoflurane also can produce convulsions and postoperative agitation. In the present report, we describe the physical and anesthetic properties of 31 cyclic ethers halogenated solely with fluorine. Although several produced anesthesia, none had solubilities that would make them better than sevoflurane. The remaining ethers were unstable or produced obvious central nervous system irritation, including convulsions. We find that none of these cyclic ethers appear to provide advantages over desflurane or sevoflurane.

Cocaine: effects of in utero exposure on the fetus and neonate.

In North America, an increasing number of babies are prenatally exposed to cocaine, yet the implications of cocaine use during pregnancy are not fully understood. The effects of cocaine are exerted primarily by its influence on aminergic receptors in the central and peripheral nervous systems. Developmental, physiological, and behavioral problems in infants and children are likely outcomes of maternal cocaine abuse, but these findings are confounded by concomitant use of other drugs such as marijuana and cocaine and by factors such as time, dosage, and route of cocaine intake. Different screening options exist for cocaine and its metabolites, including sampling of neonatal urine, hair and meconium need to be considered, as do the sensitivity and the ethical implications of such testing. Clinical management of cocaine-exposed infants requires attention to several issues, including: central nervous system irritation, cardiac anomalies, apnea, and feeding difficulties, as well as infant safety and follow-up postdischarge. Early detection and intervention remain the primary objectives of caring for cocaine-exposed infants.

Epidural Blood Patch and Late Postpartum Eclampsia

Epidural Blood Patch and Late Postpartum Eclampsia

Neonatal neurologic and electroencephalographic effects of intrauterine cocaine exposure

Thirty-nine infants with intrauterine exposure to cocaine were examined for neurologic and electroencephalographic (EEG) abnormalities. Of the 39 infants, 34 displayed central nervous system irritability, but only two of the infants required sedation. The EEGs were abnormal in 17 of 38 infants during the first week of life; abnormalities were characterized as showing central nervous system irritability. The EEG abnormalities could not be predicted on the basis of clinical neurologic dysfunction or perinatal variables. On follow-up, 9 of the 17 abnormal EEGs remained abnormal during the second week of life. One infant had an abnormal first EEG at 13 days of age. By 3 to 12 months of age, however, 9 of the 10 previously abnormal tracing had normalized and one is pending. These transient clinical and EEG abnormalities may be the result of changes in neurotransmitter availability and function.

IOHEXOL MYELOGRAPHY IN THE DOG

Myelography with iohexol (180 mg iodine/ml, 0.25 ml/kg), a new nonionic radiologic contrast medium, was performed in 100 dogs of 33 different breeds. In 96 of the dogs the iohexol mixed evenly with the cerebrospinal fluid, providing an homogeneous, continuous column of contrast medium within the subarachnoid space, and a radiologic diagnosis of a normal myelogram or disease involving the spinal cord was made. Pooling of iohexol in the dorsal part of the subarachnoid space occurred in four dogs; whether this was related to poor mixing of contrast medium with cerebrospinal fluid or disease of the spinal cord and meninges requires further study. Postmyelographic signs of central nervous system irritation (fasciculations of the temporal muscles and three episodes of seizure activity) were observed in only one dog and were controlled with diazepam. The presenting neurologic signs were aggravated after myelography in four other dogs, two of which were eventually killed. This study provided further evidence of the increased safety of iohexol compared with metrizamide, the first of the nonionic media, as a contrast medium for myelography in the dog.

1297 EARLY NEUTODEVELOPMENT IN INFANTS WITH SLIT LIKE VENTRICLES

Infants born to drug-dependent women usually undergo neonatal abstinence syndrome characterized by symptoms of central nervous system irritability, hypertonia, and diminution of the sucking reflex. The effect of fetal exposure to narcotics on the developing brain is not yet fully understood. Preliminary studies have shown that infants born to drug-dependent women tend to have ventricular configurations defined as small or slit-like during the first few days of life. The purpose of this study was to determine if a resumption of normal ventricular configuration occurs after abstinence is no longer evident and whether any developmental sequalae are evident. Ultrasound examinations, using a high resolution real-time sector scanner, were conducted on 31 infants at 24 hours and 6 months of age. All infants were born to drug dependent women and all exhibited symptoms of neonatal abstinence. Infants were assessed with the Bayley Scales of Mental Development (MDI) at 6 months of age. Results showed the presence of slit-like ventricles in 9755 of the infants during the first 24 hours of life. By 6 months of age, normal ventricular configurations were present in the majority of infants. Nine infants (29%) continued to have slit-like ventricles. However, differences in ventricular configuration were not reflected in developmental status at 6 months of age. No differences were found in the Bayley Mental Development Index scores between infants with slit-like ventricles and those with normal ventricles (t=.98, p > .20). Furthermore, developmental scores for both groups were well within the normal range of development. These results suggest that the presence of slit-like ventricles at birth do not have an adverse effect on development, at least by 6 months of age, even if resumption of normal ventricular configuration has not occurred.

The Pathophysiology of Toxaemia and Hypertension during Pregnancy

Hypertension may occur during pregnancy because of either toxaemia or hypertension without evidence of renal involvement. Toxaemia is a multisystem disease, typically occurring in late pregnancy, with hypertension, proteinuria, oedema, and central nervous system irritability. Since convulsions may occur with severe toxaemia, the disease has been divided into eclampsia and pre-eclampsia, based on whether a seizure has occurred. Toxaemia accounts for approximately 70% of hypertension seen in pregnant women.

Prolonged seizures associated with the use of viscous lidocaine

INADVERTENT 1NTRAVASCULAR INJECTION, overdosage, or rapid absorption of local anesthetics may produce profound side effects, the most serious of which are seizures. All local anesthetics have the potential to cause central nervous system irritability resulting from blockade of cerebral cortical inhibitory pathways. The more potent the anesthetic, the lower the blood concentration associated with seizures. We report two cases of prolonged seizures following the prescribed use of 2% viscous lidocaine in children. Seizures associated with the use of viscous lidocaine have been previously reported in a child, presumably related to an accidental ingestion, l The purpose of this report is to call attention to the potential hazard of this preparation when used therapeutically.

TOXICITY FROM TEA INGESTION IN AN INFANT: A COMPUTER SIMULATION ANALYSIS

A seven week old previously healthy infant presented with tonic posturing and central nervous system irritability after concentrated tea ingestion. Using a gas chromatographic analysis technique, a sample of similarly prepared tea was examined for levels of caffeine, theophylline, and theobromine. Caffeine was the only xanthine found in the tea. A simulation of caffeine absorption and elimination was performed on a computer utilizing Euler's method on a three compartment model consisting of caffeine in the gut, in the body water, and caffeine excreted. Convulsions after caffeine administration have been reported at doses of 7 mg/kg. In our patient, the total estimated ingested dose of caffeine was 75 mg or 14.7 mg/kg with a maximum predicted blood level at 3 2/3 hours. A xanthine blood level from the infant at 5 hours was 1.1 mg/100 ml compared to a computer predicted value of 1.3 mg/100 ml. Computer simulation may be utilized to predict the pharmacologic course and distribution of ingested agents.