Bilateral Acute Necrosis of the Globi Pallidi and Rhabdomyolysis Due to Combined Methadone and Benzodiazepine Toxicity

Corliss, Robert F.; Mandal, Rakesh; Soriano, Benjamin J.

doi:10.1097/paf.0b013e31823a8b1e

Cited by 22 publications

(14 citation statements)

References 22 publications

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“…Although these findings are not specific, such symptoms are in part consistent with the current behavioral results. Acute cerebellitis ( Mills et al, 2008 ; Rando et al, 2016 ) or basal ganglia ( Cottencin et al, 2009 ; Corliss et al, 2013 ) damage involvement following methadone overdose may explain the motor impairment observed in the pole and rotarod tasks caused in part by overstimulation of opioid receptors in these brain regions.…”

Section: Discussionmentioning

confidence: 99%

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats

et al. 2018

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Methadone is used as a substitution drug for the treatment of opioid dependence and chronic pain. Despite its widespread use and availability, there is a serious concern with respect to the relative safety of methadone. The purpose of this study was to characterize how acute methadone overdose affects the cognitive and motor performance of naïve healthy rats. The methadone overdose was induced by administering an acute toxic dose of methadone (15 mg/kg; ip; the equivalent dose of 80% of LD50) to adolescent rats. Resuscitation using a ventilator pump along with a single dose of naloxone (2 mg/kg; ip) was administered following the occurrence of apnea. The animals which were successfully resuscitated divided randomly into three apnea groups that evaluated either on day 1, 5, or 10 post-resuscitation (M/N-Day 1, M/N-Day 5, and M/N-Day 10 groups) in the Y-maze and novel object memory recognition tasks as well as pole and rotarod tests. The data revealed that a single toxic dose of methadone had an adverse effect on spontaneous behavior. In addition, Recognition memory impairment was observed in the M/N-Day 1, 5, and 10 groups after methadone-induced apnea. Further, descending time in the M/N-Day 5 group increased significantly in comparison with its respective Saline control group. The overall results indicate that acute methadone-overdose-induced apnea produced delay-dependent cognitive and motor impairment. We suggest that methadone poisoning should be considered as a possible cause of delayed neurological disorders, which might be transient, in some types of memory or motor performance in naïve healthy rats.

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Section: Discussionmentioning

confidence: 99%

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats

et al. 2018

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“…Methadone is a highly lipid soluble synthetic opioid, and it is well-absorbed in the brain with a strong affinity for u -opioid receptors 12 , which are predominately located in the limbic system and the cerebellum in humans 13 14 . Although methadone has similar chemical properties and receptor-mediated actions to heroin, relatively specific regional effects of methadone have been reported.…”

Section: Discussionmentioning

confidence: 99%

Methadone-induced Damage to White Matter Integrity in Methadone Maintenance Patients: A Longitudinal Self-control DTI Study

Wang

et al. 2016

Sci Rep

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Methadone maintenance treatment (MMT) can induce impairments in brain function and structure, despite its clinical effectiveness. However, the effect of chronic MMT on brain white matter (WM) is not fully known. Thirty-three MMT patients underwent diffusion tensor imaging (DTI) twice – at the start of the study (Scan1) and one year later (Scan2). Tract-based spatial statistics were used to investigate changes in fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) between the two scans. The correlations between DTI indices and methadone consumption and neuropsychological status were analysed. We found significantly decreased FA, decreased AD and increased RD in Scan2 in extensive WM regions; overlapping regions were found in the left posterior limb and the retrolenticular part of internal capsule, superior and posterior corona radiata, bilateral external capsule and the right superior longitudinal fasciculus. In addition, the change of FA in the overlapping regions was positively correlated with the accumulated dosage of methadone use, the RD value in Scan2 and non-planning impulsiveness (NPI) measured at follow-up. The results suggest that methadone has damaging effects on WM integrity. The dose-dependent pattern and characteristics of the impairment may suggest new strategies for MMT.

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“…A combination of cocaine and alcohol resulting in unconsciousness has also produced bilateral basal ganglia lesions ( 18 ). There was an additional case of bilateral basal ganglia lesions with methadone and benzodiazepines ( 19 ), but as can be seen from the above cases, the majority involved a stimulating drug. Finally, an autopsy series of consecutive cases of bilateral globus pallidus necrosis found that 10 of 27 cases involved drug overdose, more than any other etiology ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

et al. 2017

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We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia.

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Bilateral Acute Necrosis of the Globi Pallidi and Rhabdomyolysis Due to Combined Methadone and Benzodiazepine Toxicity

Cited by 22 publications

References 22 publications

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats

Methadone-induced Damage to White Matter Integrity in Methadone Maintenance Patients: A Longitudinal Self-control DTI Study

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

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