Myoclonus following spinal anesthesia

Fox, Elisabeth J.; Villanueva, Raymond; Schutta, Henry S.

doi:10.1212/wnl.29.3.379

Cited by 44 publications

(18 citation statements)

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“…In another case, 14 mg of tetracaine with 10% dextrose in combination with 0.2 mg of epinephrine was injected. Spinal myoclonus developed approximately 7 h after administration of anesthesia and lasted a few hours [4]. Lin et al [5] reported a patient who underwent spinal anesthesia with 2.5 ml of 0.5% hypobaric bupivacaine, administered via a 26-G spinal needle.…”

Section: Discussionmentioning

confidence: 99%

Recurrent spinal myoclonus after two episodes of spinal anesthesia at a 1-year interval -A case report-

Lee

Hwang

Lee

et al. 2010

Korean J Anesthesiol

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Spinal myoclonus is an unusual, self-limiting, adverse event that may occur during spinal anesthesia. The exact cause and underlying biochemical mechanism of spinal myoclonus remain unclear. A few cases of spinal myoclonus have been reported after administration of intrathecal bupivacaine. We report a case in which spinal myoclonus recurred after two episodes of spinal anesthesia with bupivacaine at a 1-year interval in a 35-year-old woman. The myoclonus was acute and transient. The patient recovered completely, with no neurologic sequelae.

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Section: Discussionmentioning

confidence: 99%

Recurrent spinal myoclonus after two episodes of spinal anesthesia at a 1-year interval -A case report-

Lee

Hwang

Lee

et al. 2010

Korean J Anesthesiol

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“…This has been reported by Fox et al (1979), with tetracaine in combination with epinephrine, and by Nadkarni and Tondare (1982), with lidocaine in combination with epinephrine. The latter authors hypothesised that the concomitant action of local anaesthetic and epinephrine caused ischaemia in the spinal cord, with resultant transient and localised seizure-like spinal activity.…”

Section: Local Anaestheticsmentioning

confidence: 68%

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

1990

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Many classes of pharmacological agents have been implicated in cases of drug-induced seizures. The list includes antidepressant drugs, lithium salts, neuroleptics, antihistamines (H1-receptor antagonists), anticonvulsants, central nervous system stimulants, general and local anaesthetics, antiarrhythmic drugs, narcotic and non-narcotic analgesics, non-steroidal anti-inflammatory drugs, antimicrobial agents, antifungal agents, antimalarial drugs, antineoplastic drugs, immunosuppressive drugs, radiological contrast agents and vaccines. For each of these classes of drugs, this article offers a revision of the literature and emphasises in particular the frequency of the adverse reaction, its clinical presentation, its presumed epileptogenic mechanism and the therapeutic strategy for the management of drug-induced seizures. An attempt is also made to distinguish seizures induced by standard dosages from those provoked by accidental or self-induced intoxication. For some classes of drugs such as antidepressants, neuroleptics, central nervous system stimulants (e.g. theophylline, cocaine, amphetamines) and beta-lactam antibiotics, seizures are a well recognised adverse reaction, and a large body of literature has been published discussing exhaustively the major aspects of the issue; sufficient data are available also for the other classes of pharmacological agents mentioned above. In contrast, several other drugs [e.g. allopurinol, digoxin, cimetidine, protirelin (thyrotrophin releasing hormone), bromocriptine, domperidone, insulin, fenformin, penicillamine, probenecid, verapamil, methyldopa] have not been studied thoroughly under this aspect, and the only source of information is the occasional case report. This review does not address the issue of seizures induced by drug withdrawal.

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“…Shibasaki and Hallett [9] reported that the pathophysiology of spinal myoclonus was related to abnormal hyperactivity of the local dorsal horn interneurons with loss of inhibition of suprasegmental descending pathways. Some have suggested that the inhibitory effects of a local anesthetic may cause increased irritability of α-motor neurons, leading to the development of myoclonus [3].…”

Section: Discussionmentioning

confidence: 99%

“…The causes of spinal myoclonus include tumors, infection, trauma, and degenerative disease [2]. In rare cases, spinal myoclonus has been induced by the administration of certain drugs via neuraxial routes [3][4][5]. There are few reports of spinal myoclonus following spinal anesthesia or combined spinal-epidural anesthesia, and spinal myoclonus after epidural anesthesia is extremely rare [6].…”

Section: Introductionmentioning

confidence: 99%