Netto Ivan, Phutane Vivek H
Parmar Plaza Clinic, Fatimanagar, Pune, Maharashtra, India.
Prim Care Companion CNS Disord. 2012;14(1). doi: 10.4088/PCC.11r01197.
Lithium neurotoxicity may be reversible or irreversible. Reversible lithium neurotoxicity has been defined as cases of lithium neurotoxicity in which patients recovered without any permanent neurologic sequelae, even after 2 months of an episode of lithium toxicity. Cases of reversible lithium neurotoxicity differ in clinical presentation from those of irreversible lithium neurotoxicity and have important implications in clinical practice. This review aims to study the clinical presentation of cases of reversible lithium neurotoxicity.
A comprehensive electronic search was conducted in the following databases: MEDLINE (PubMed), 1950 to November 2010; PsycINFO, 1967 to November 2010; and SCOPUS (EMBASE), 1950 to November 2010. MEDLINE and PsycINFO were searched by using the OvidSP interface.
A combination of the following search terms was used: lithium AND adverse effects AND central nervous system OR neurologic manifestation. Publications cited include articles concerned with reversible lithium neurotoxicity.
The age, sex, clinical features, diagnostic categories, lithium doses, serum lithium levels, precipitating factors, and preventive measures of 52 cases of reversible lithium neurotoxicity were extracted.
Among the 52 cases of reversible lithium neurotoxicity, patients ranged in age from 10 to 80 years and a greater number were female (P = .008). Most patients had affective disorders, schizoaffective disorders, and/or depression (P < .001) and presented mainly with acute organic brain syndrome. In most cases, the therapeutic serum lithium levels were less than or equal to 1.5 mEq/L (P < .001), and dosage regimens were less than 2,000 mg/day. Specific drug combinations with lithium, underlying brain pathology, abnormal tissue levels, specific diagnostic categories, and elderly populations were some of the precipitating factors reported for reversible lithium neurotoxicity. The preventive measures were also described.
Reversible lithium neurotoxicity presents with a certain clinical profile and precipitating factors for which there are appropriate preventive measures. This recognition will help in early diagnosis and prompt treatment of lithium neurotoxicity.
锂神经毒性可能是可逆的或不可逆的。可逆性锂神经毒性被定义为锂神经毒性病例，即患者即使在锂中毒发作2个月后仍能康复且无任何永久性神经后遗症。可逆性锂神经毒性病例的临床表现与不可逆性锂神经毒性病例不同，在临床实践中具有重要意义。本综述旨在研究可逆性锂神经毒性病例的临床表现。
在以下数据库中进行了全面的电子检索：MEDLINE（PubMed），1950年至2010年11月；PsycINFO，1967年至2010年11月；以及SCOPUS（EMBASE），1950年至2010年11月。通过OvidSP界面检索MEDLINE和PsycINFO。
使用以下检索词组合：锂与不良反应与中枢神经系统或神经表现。引用的出版物包括与可逆性锂神经毒性相关的文章。
提取了52例可逆性锂神经毒性病例的年龄、性别、临床特征、诊断类别、锂剂量、血清锂水平、诱发因素和预防措施。
在52例可逆性锂神经毒性病例中，患者年龄在10至80岁之间，女性患者较多（P = 0.008）。大多数患者患有情感障碍、分裂情感障碍和/或抑郁症（P < 0.001），主要表现为急性器质性脑综合征。在大多数情况下，治疗性血清锂水平小于或等于1.5 mEq/L（P < 0.001），给药方案小于2000 mg/天。与锂的特定药物组合、潜在的脑部病变、异常的组织水平、特定的诊断类别和老年人群是报道的可逆性锂神经毒性的一些诱发因素。还描述了预防措施。
可逆性锂神经毒性具有一定的临床特征和诱发因素，对此有适当的预防措施。这种认识将有助于锂神经毒性的早期诊断和及时治疗。
