Clonic Contractions Research Articles

LITHIUM CARBONATE POISONING

A case of manic-depressive illness with sever lithium carbonate poisoning taking a long time to recovery, is reported.In this case, symptoms consisted of lethargy, fever, vomiting, tremor, lateral rotation of the head, upward gaze, conjugate lateral deviation of the eyes, anisocoria, nystagmus, muscle fasciculation, clonic contractions of large muscle groups, hyperactive tendon reflexes, Babinski sign positive, ataxia, and snout and grasp reflexes.Laboratory studies showed the following, leucocytosis and the elevated levels of serum GOT, GPT, LDH, BUN. Electroencephalograms showed generalized slowing. Cerebrospinal fluid examinations were normal.Within one month period, these acute toxic symptoms disappeared. EEG became normal after five months. The maximum serum level of lithium ion reached to 5.03 mEq / L. Twenty one days later, serum level of lithium ion was no longer presented. Six months later, a pneumoencephalogram showed slight dilatation of the lateral ventricles and widened cortical sulci in the frontal area.We also recognized mask-like facies, dysarthric, monotonous and low pitches speech, limb ataxia, dementia and change in personality. These clinical symptoms are gradually improving.In this case, in spite of lowere dosages as 400 mg/day lithium carbonate, it showed high serum lithium ion level as 5.08 mEq/L, when clinical toxic symptoms appeared.We thought, during the transition from mania to depression, the total body water was decreased, moreover the diet and liquid intake was reduced, in consequence serum lithium ion level increased and severe intoxication appeared.Prevention of intoxication required administration of proper dosage and maintaining laboratory and clinical control during treatment.

ADVERSE REACTIONS TO INTRAVENOUS ANAESTHETICS: A Survey of 100 Reports

One hundred consecutive reports of reactions to intravenous anaesthetics Althesin, thiopentone and Epontol are reviewed and analysed. Ten reactions are attributed to causes other than the anaesthetic drug, and four are believed to have been caused by the muscle relaxant employed. The remaining 86 reactions were grouped according to their clinical presentation: histaminoid reactions ( 19), histaminoid with bronchospasm (33), bronchospasm (12), cardiovascular collapse (uu), delayed histaminoid reactions (6), and clonic contractions (5). None of the first four reaction types was associated with only one anaesthetic. A knowledge of the sales of Althesin has allowed the incidence of reactions to be estimated as between one in 11,000 and one in 19,000.

Thresholds of cortical activation of muslce spindles and alpha motoneurones of the baboon's hand.

1. Much current thinking about voluntary movement assumes that the segmental gamma loops can function as a servomechanism operated by the brain. However, the alpha motoneurones of the baboon's hand receive a powerful monosynaptic (CM) projection from the precentral gyrus. If servo-driving from the same cortical area is to be possible, it must project independently to the fusimotor neurones and have sufficient power to increase the afferent signalling from the muscle spindles. The cortical thresholds for contraction of m. extensor digitorum communis and for acceleration of the discharges of its muscle spindles have therefore been compared.2. Significant results in this context require that the spindles studied be coupled in parallel with the responding extrafusal muscle fibres. Many spindles were not unloaded by the submaximal contractions evoked by cortical stimulation, although all so tested were unloaded by maximal motor nerve twitches. Reasons are given for thinking that such apparent lack of parallel coupling is an artifact of complex intramuscular anatomy and limitation of shortening by ;isometric' myography.3. A brief burst of corticospinal volleys at 500/sec, which is specially effective in exciting alpha motoneurones over the CM projection, failed to excite spindle afferents at or below the threshold for a cortical ;twitch'.4. In a few epileptiform discharges, bursts of spindle acceleration occurred independently of the clonic contractions. A relatively direct and independent cortico-fusimotor (CF) projection may therefore exist.5. Prolonged near-threshold stimulation at 50-100/sec, which allows time for temporal summation in the less direct projections (e.g. cortico-interneuronal, cortico-rubro-spinal) and does not cause frequency-potentiation at CM synapses, gives abundant evidence of independent alpha and fusimotor projections, whose actions hardly outlast the stimulation period.6. Although independent CF projections would permit servo-driving in natural movements of the hand (given adequate loop gain), there has been no evidence of servo-driving by cortical stimulation or in the spontaneous contractions of light anaesthesia.7. Independent projections would provide for controlled alphagamma co-excitation in the servo-governing of natural movements (Matthews, 1964).8. Evidence is reviewed that the CM projection itself may be part of an important control loop for voluntary movement in primates. A corollary would be a diminished importance of CF projections for segmental loops and an increased importance for maintaining the spindle input to cortical loops.

Epilepsy Induced by Cardiac Pacemaker

FOR MANY YEARS it has been recognized that specific sensory stimuli can precipitate convulsive attacks in susceptible individuals. Such reflex or sensory precipitated epilepsy (SPE) is uncommon and is found in only 5% to 7% of patients with epilepsy.^1,2The following communication describes an unusual type of SPE in which seizures were initiated by the periodic discharge of an implanted cardiac pacemaker. To our knowledge, this is the first reported case of pacemaker-induced epilepsy. <h3>Report of a Case</h3> A 72-year-old white woman was admitted to the University of Kentucky Hospital on Nov 25, 1964, with a history of seizures which had begun three days prior to admission. The attacks occurred several times a day and were accompanied by tonic and clonic contractions, tongue biting, and unconsciousness. They were preceded by an aura of bright lights and noises and left the patient feeling dizzy and tired. Although she reported frequent

Epilepsy induced by cardiac pacemaker

FOR MANY YEARS it has been recognized that specific sensory stimuli can precipitate convulsive attacks in susceptible individuals. Such reflex or sensory precipitated epilepsy (SPE) is uncommon and is found in only 5% to 7% of patients with epilepsy.^1,2The following communication describes an unusual type of SPE in which seizures were initiated by the periodic discharge of an implanted cardiac pacemaker. To our knowledge, this is the first reported case of pacemaker-induced epilepsy. <h3>Report of a Case</h3> A 72-year-old white woman was admitted to the University of Kentucky Hospital on Nov 25, 1964, with a history of seizures which had begun three days prior to admission. The attacks occurred several times a day and were accompanied by tonic and clonic contractions, tongue biting, and unconsciousness. They were preceded by an aura of bright lights and noises and left the patient feeling dizzy and tired. Although she reported frequent

Acarinose dos sacos aéreos de canários (Serinus canarius L.) e periquitos australianos (Melopsittacus undulatus, Shaw 1805) por Cytodites nudus (Vizioli, 1868)

In this paper the authors describes, in a group of canaries, a bronchitis caused by an infestation of the air sacs, by Cytodites nudus (Vizioli, 1868). They further described the observed symptoms, mainly those which are due to the disturbance of the breathing system (intense dyspnea, cough, sneezing, noisy breathing and congestion of the larynx) and those of exciting of the neural system (convulsions with tonic and clonic contractions). The more frequent lesions are: inflammation of the air sacs, with the presence of liquids, mucus and blood coagulum in the cavities. Pericarditis and adherences of the pericardium to the thorax walls. The treatment was based, on fluidifiers and expectorants of secretions, containing either potassium iodide or sodium benzoate. There were often found ectoparasites among the breedings, from which came our cases, for which treatment the Sodium fluoride was utilized. The clinics diagnosis was confirmed by necroscopy performed on the patients or on other birds of the same breedings, with similar symptoms. The authors also describes the incidence of Cytodites nudus in the air sacs of Australian Parakeets (Melopsittacus undulatus —Shaw, 1805).

Clinical results with methocarbamol, a new interneuronal blocking agent.

Methocarbamol was administered to approximately 110 patients with various forms of neuromuscular disease marked by involuntary muscular activity. Given intravenously, the drug caused significant reduction of both involuntary tonic and clonic contractions in 30 patients whose symptoms were ascribed to lesions of the pyramidal tracts or to acute myalgic disorders. If relief was obtained, it appeared within 30 to 45 minutes. The results were sufficiently striking to warrant more thorough investigation.

The use of arfonad for the alleviation of cardio-vascular stress following electro-convulsive therapy.

The safety of electro-convulsive therapy (E.C.T.) has been greatly increased since muscle relaxants were first introduced for this purpose. Short-acting relaxants such as suxamethonium and suxethonium reduce the usual strong tonic and clonic contractions to faint muscle twitchings, and fractures do not occur. Respiration can be maintained throughout by positive pressure inflation so that cyanosis and stertorous breathing are avoided. This may ensure that material from small pulmonary lesions is not disseminated to other areas. It is disappointing that the cardiovascular commotion is only slightly reduced, and deaths still occur, albeit rarely.

Palatal myoclonus; report of three cases.

PALATAL myoclonus is a neurologic symptom complex, which apparently occurs with sufficient frequency to be of interest to the otolaryngologist. This obscure phenomenon consists in clonic contractions of one or more of the muscles attached to the eustachian tube and soft palate and a synchronous ticking noise easily audible to both patient and observer. The contractions are not rhythmic, as a rule, and their rate varies in individual cases from as few as 80 to 140 or 150 per minute. They may appear either as a small dimpling of the soft palate or as a complete elevation of one or both palatal arches and uvula. The tinnitus is best described as a ticking or clicking noise and can be simulated by the snapping of one finger nail over another. The sound may be heard at distances varying from that of direct contact with the patient's ear to several feet. Nasopharyngoscopic

The treatment of mental defectives with thiamine.

Thiamine or aneurine has for many years been known as the anti-neuritic vitamin, although action of this substance in organic nervous trouble is not established. Less well-known is its action on the higher cerebral processes, but results of investigations appear to show that it has a definite effect on these. M. V. Dias (1947) found that the application of thiamine hydrochloride solution to the motor cortex of unanaesthetized dogs produced clonic contractions of the appropriate muscles, and Harrell (1946) reports striking psychological results on normal children.

Effect of Acidosis in Strychnine Poisoning.

It has been demonstrated by a number of investigators that changes in the reaction of the blood toward the acid side prevent the clonic contraction and spasticity of the skeletal muscles in parathyroid tetany. The experiments reported here show that a decrease in the pH of the blood produced prior to the administration of lethal doses of strychnine, prevents violent tetanus, convulsions and death. Acidosis was produced in 7 dogs by subcutaneous injections of nephro-toxic substances such as uranium nitrate and sodium tartrate. When the pH of the blood dropped to about 7.2 and the CO2 capacity to around 22 volumes %, the dogs received subcutaneously 1/160 gr. per kilo of strychnine sulphate. Ten minutes later slight muscle tremors and spasms developed. In all cases recovery occurred within 45 minutes. One dog died 1 hour following injection of the lethal dose of strychnine. In this case death was apparently due to uranium nitrate poisoning. In other series of dogs acidosis was produced by means other than those involving impairment of renal function. This was brought about by administering NH4Cl to one series of animals and CO2 to another. Muscle spasms from which the dogs soon recovered, followed the injections of a lethal dose of strychnine. From the results we obtained it is evident that it is the initial drop in pH occurring before injection of the strychnine and not the fall produced by convulsions and the resulting anoxemia that is effective in preventing convulsions and death from strychnine poisoning. The data from 1 of our experimental and 1 of our control dogs are presented in Table I.

Studies on inorganic salt metabolism. II. The effect of the sudden alteration of the acid-base balance of the diet on dogs.

During the course of a study on inorganic salt metabolism in dogs which has been in progress in this laboratory for the past 4 years, it has frequently been observed that convulsions, usually followed by death, occur in the experimental animals after the sudden alteration of the acid-base balance of the diet. The convulsions appear to result from an increase in the acid or alkali content of the diet beyond the limit of tolerance of the animal as well as after the sudden reversal of the dietary reaction. The nutritive condition of the dogs has been excellent, there having been no known dietary fault other than a disproportion of its acid-base balance. The onset of the symptoms has been sudden, the attacks, which are characterized by marked twitching, clonic contractions of the limbs, rapid respiration, gasping for breath and excessive salivation, are of short duration, as a rule. The animals recover quickly and appear to be hungry, eating with relish any food that may be available. From the standpoint of our studies, no significance was at first attached to these observations, the condition being attributed to other causes. It occurred, however, with such frequency, and the convulsive attacks were so similar in the various animals affected, that it seemed there must be some common underlying cause. In order to determine whether or not a disturbance in the acid-base balance of the diet was an etiological factor in producing this condition the following experiment was planned : Five large adult dogs, 4 females and 1 male, ranging in age from 3 to 8 years, and 2 puppies, 5 months of age were used. All of the animals appeared to be in excellent physical condition.

Case of Partial Oculomotor Paralysis, with Synchronous Clonic Contractions of Muscles Supplied by the Third Cranial Nerve

Case of Partial Oculomotor Paralysis, with Synchronous Clonic Contractions of Muscles Supplied by the Third Cranial Nerve