Dexmedetomidine controls twitch-convulsive syndrome in the course of uremic encephalopathy

Nomoto, Koichi; Scurlock, Corey; Bronster, David J.

doi:10.1016/j.jclinane.2011.01.011

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…These result in excess nitric oxide, increase glutamate release and excitotoxicity. This is further supported by the finding that methyl guanidine (a uremic toxin) can induce uremic twitch-convulsive syndrome, a condition similar to uremic encephalopathy with seizures [22].…”

Section: Uremic Seizures With Chronic Kidney Disease: Clinical Types Possible Mechanisms and Response To Treatmentsmentioning

confidence: 77%

“…(2) acute symptomatic seizures without an established diagnosis of epilepsy due to complications of kidney failure (as brain edema due to uremic encephalopathy with/without metabolic derangements or hypertensive encephalopathy) [20,21]. (3) acute symptomatic seizures during or just after dialysis due to hemodynamic instability [22]. (4) recurrent seizures in absence of encephalopathy or obvious metabolic derangements which could explain their occurrence.…”

Section: Uremic Seizures With Chronic Kidney Disease: Clinical Types Possible Mechanisms and Response To Treatmentsmentioning

confidence: 99%

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Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments

Hamed¹,

Abdulhamid²,

Elhadad³

2021

J Neurol Exp Neurosci

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Background and objectives: Recurrent seizures are a consequence of uremia due to chronic kidney disease (CKD). This study was aimed to determine types, frequencies, causes and treatments of uremic seizures and their independent predictors. Methods: Seventy adults (male = 33; female = 37) were included. They had mean age of 45.87 ± 3.36 years and duration of kidney failure (stage 3-5) of 5.53 ± 1.53 years. They underwent clinical and laboratory investigations and electroencephalography (EEG) and brain neuroimaging.Results: Eleven patients (15.7%; on dialysis = 6, not on dialysis = 5) developed recurrent seizures after the development of CKD. Six had (54.55%) generalized tonic-clonic (GTC) seizures, of them 4 (66.67%) had tetany, hypocalcemia (< 6 mg/dl), hyperparathyroidism and brain calcifications. Five (45.45%) had focal to bilateral GTC seizures, focal electroencephalography (EEG) epileptic discharges and white matter ischemic hyperintensities in their brain magnetic resonance imaging. Epileptic EEG discharges (spikes and spike-wave complexes) were found in 24.3% (n = 17) in absence of seizures. Compared to those without seizures, the majority of patients with seizures had end stage kidney disease (ESKD), metabolic derangements and neuroimaging abnormalities. Multiple regression analysis showed that the presence of uremic seizures was independently correlated to the severity of kidney failure (OR = 1.25, 95% Cl = 1.08-1.30, P = 0.01) and metabolic derangements (OR = 2.44; 95% CI = 1.25-2.80, P = 0.01). Conclusion:Recurrent seizures are common with uremia. The progression of uremia and its acute manifestations (as uremic encephalopathy with/of without metabolic derangements) were the most common precipitating factors for uremic seizures. Improvements of seizures occurred with hemodialysis and correction of metabolic derangements.

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Section: Uremic Seizures With Chronic Kidney Disease: Clinical Types Possible Mechanisms and Response To Treatmentsmentioning

confidence: 77%

Section: Uremic Seizures With Chronic Kidney Disease: Clinical Types Possible Mechanisms and Response To Treatmentsmentioning

confidence: 99%

Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments

Hamed¹,

Abdulhamid²,

Elhadad³

2021

J Neurol Exp Neurosci

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“…Its ability to control shivering has been documented in healthy volunteers subjected to hypothermia and attributed to central inhibition of systemic catecholamine release through N-methyl- D -aspartate (NMDA)-mediated autonomic hyperactivity [28], in a similar way in which it has shown efficacy in controlling tremor related to acute alcohol withdrawal syndrome [29,30,31]. A similar case has been reported with uremic encephalopathy-related tremor, which is also thought to be ultimately caused by increased NMDA activity and catecholamine release [15]. …”

Section: Discussionmentioning

confidence: 99%

“…However, the possibility of interference of DEX with the assessment of motor symptoms (tremor or rigidity) is not well documented, and a few case reports have been published describing DEX influence over these symptoms in clinical settings different from PD surgery [14,15]. Identifying factors that may cause or contribute to this interference could promote a better anesthetic management of these surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Tremor Changes during Sedation with Dexmedetomidine in Parkinson's Disease Surgery

Honorato‐Cia

Martínez-Simón²,

Alegre³

et al. 2015

Stereotact Funct Neurosurg

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Introduction: Dexmedetomidine is an α₂-agonist recently proposed as a potentially ideal drug for sedation during the surgical treatment of Parkinsonʼs disease (PD). This report documents the incidence of changes in motor symptoms (especially tremor) in PD patients sedated with dexmedetomidine for deep brain stimulation or ablation procedures. Methods: We reviewed a retrospective cohort of 22 patients who underwent surgery for PD with dexmedetomidine sedation at a single institution from 2010 to 2014. A logistic regression analysis was performed to analyze possible confounding factors. Results: 14 cases of tremor reduction or suppression were recorded (cumulative incidence: 63.6%; 95% CI: 40.7-82.8). No association could be identified between loading dose, β-blocker use and preoperative total Unified Parkinson's Disease Rating Scale III, with tremor changes. The maintenance dose of dexmedetomidine was higher in patients who did not experience changes [median and range for patients with and without tremor alteration 0.75 (0.2-1.0) and 1.0 µg × kg^-1 × h^-1 (0.7-1.4), respectively; p = 0.021]. Conclusion: Dexmedetomidine provides adequate sedation during surgery for PD, but it might affect motor signs making intraoperative testing difficult or even impossible. Dosage appears not to be the determining factor in motor changes, whose cause remains unclear.

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“…Lepiej niż benzodiazepiny znosi ona pobudzenie u chorych leczonych na oddziałach neurologicznych, którzy nie wymagają intubacji dotchawiczej [37]. Jest też skuteczna w opanowywaniu drgawek u chorych z przewlekłą chorobą nerek i encefalopatią mocznicową [38]. Rutkowska i wsp.…”

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Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

Wujtewicz

Maciejewski²,

Misiołek³

et al. 2014

Anaesthesiol Intensive Ther

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Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.

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Dexmedetomidine controls twitch-convulsive syndrome in the course of uremic encephalopathy

Cited by 9 publications

References 16 publications

Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments

Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments

Factors Associated with Tremor Changes during Sedation with Dexmedetomidine in Parkinson's Disease Surgery

Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

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