thiopental and Dyskinesia--Drug-Induced

New onset refractory status epilepticus (NORSE) is a neurological emergency and difficult to treat condition. We report a case of involuntary movements resulting from thiopentone sodium infusion during the management of refractory status epilepticus. A young woman was admitted with fever and NORSE in the neurology intensive care unit. In addition to supportive measures, she was treated with intravenous lorazepam, phenytoin sodium, sodium valproate, midazolam and thiopentone sodium. While on thiopentone sodium, she developed involuntary twitches involving her upper limbs and face with EEG showing no evidence of ongoing status epilepticus. Because of the temporal relationship with thiopentone infusion, we tapered the dose of thiopentone sodium, which resulted in the disappearance of the movements. The patient recovered well with no recurrence of the seizures during the hospital stay.

Topics: Anticonvulsants; Diagnosis, Differential; Dyskinesia, Drug-Induced; Electroencephalography; Female; Humans; Status Epilepticus; Thiopental; Treatment Failure; Young Adult

Thiopental is an anesthetic used for controlling high intracranial pressure (ICP) caused by brain surgery, brain trauma, and severe stroke. However, it remains controversial whether Thiopental is detrimental or beneficial in ischemic stroke. In this study, we used an animal model of ischemic stroke in spontaneously hypertensive rats to determine whether or not Thiopental is neuroprotective in the setting of brain ischemia. We observed that Thiopental caused a prolonged duration of unconsciousness with a high rate of mortality, that Thiopental created exaggerated neurological deficits that were revealed through limb placement tests at 4 days and 4 weeks after brain ischemia, and that infarct volume was increased in Thiopental-anesthetized rats. These data suggest that Thiopental is detrimental in ischemic stroke. Thus, our findings raise a caution about the use of Thiopental in the setting of ischemic stroke.

Topics: Anesthetics, Intravenous; Animals; Brain; Brain Ischemia; Chloral Hydrate; Disease Models, Animal; Dyskinesia, Drug-Induced; Magnesium Sulfate; Male; Methohexital; Pentobarbital; Random Allocation; Rats; Rats, Inbred SHR; Stroke; Thiopental; Time Factors; Treatment Outcome; Unconsciousness

A 44 year old woman with a severe drug induced tardive dyskinesia had previously been treated with a left thalamotomy and right deep brain stimulation. Thalamotomy abolished the right hemiballismus. Deep brain stimulation caused a moderate reduction of the remaining involuntary movements on the left side. After a minor orthopaedic operation under general anaesthesia, the dyskinesia disappeared completely, even with the deep brain stimulation turned off. The remission has now lasted for 41 months.

Topics: Adult; Androstanols; Anesthetics, General; Antipsychotic Agents; Brain; Dyskinesia, Drug-Induced; Female; Femoral Neck Fractures; Fentanyl; Flupenthixol; Humans; Isoflurane; Neurosurgical Procedures; Receptors, Dopamine; Remission Induction; Rocuronium; Thalamus; Thiopental