Strychnine-like multifocal myoclonus and seizures in extremely high-dose opioid administration: Treatment strategies

被引:51
作者
Hagen, N [1 ]
Swanson, R [1 ]
机构
[1] UNIV CALGARY,FAC MED,CALGARY,AB,CANADA
关键词
opioid; toxicity; myoclonus; seizures; cancer pain;
D O I
10.1016/S0885-3924(97)00001-8
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
While occasional myoclonic jerks are prevalent in cancer patients receiving opioids, severe myoclonic jerks and seizures due to opioids are uncommon. In this retrospective case series, we describe five cancer patients with refractory cancer patients withe refractory cancer pain and severe neuroexcitatory toxicity associated with extremely high-dose opioid therapy to characterize better the syndrome, its treatment, and its outcome. Two patients died following seizures, but three patients recovered following prompt treatment with parenteral midazolam infusions and rotation to alternative opioids. Possible mechanisms and treatment options for this potentially lethal clinical syndrome are reviewed. The authors conclude that severe multifocal myoclonus and seizures associated with extremely high-dose opioid therapy are lift-threatening, and respond to parenteral midazolam infusion, rotation to alternative opioids, and aggressive supportive care. (C) U.S. Cancer Pain Relief Committee, 1997.
引用
收藏
页码:51 / 58
页数:8
相关论文
共 27 条
[1]   HYDROMORPHONE METABOLITE ACCUMULATION IN RENAL-FAILURE [J].
BABUL, N ;
DARKE, AC ;
HAGEN, N .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1995, 10 (03) :184-186
[2]  
BABUL N, 1993, PAIN, V52, P260
[3]  
BOHN HP, 1992, AM J NEURORADIOL, V13, P1515
[4]  
CHALLONER K R, 1990, Journal of Emergency Medicine, V8, P67, DOI 10.1016/0736-4679(90)90391-8
[5]   CLASSIFICATION OF OPIOIDS ON THE BASIS OF CHANGE IN SEIZURE THRESHOLD IN RATS [J].
COWAN, A ;
GELLER, EB ;
ADLER, MW .
SCIENCE, 1979, 206 (4417) :465-467
[6]   HYPERALGESIA AND MYOCLONUS WITH INTRATHECAL INFUSION OF HIGH-DOSE MORPHINE [J].
DECONNO, F ;
CARACENI, A ;
MARTINI, C ;
SPOLDI, E ;
SALVETTI, M ;
VENTAFRIDDA, V .
PAIN, 1991, 47 (03) :337-339
[7]   CLONAZEPAM TREATMENT OF MYOCLONIC CONTRACTIONS ASSOCIATED WITH HIGH-DOSE OPIOIDS - CASE-REPORT [J].
EISELE, JH ;
GRIGSBY, EJ ;
DEA, G .
PAIN, 1992, 49 (02) :231-232
[8]   NONLINEAR OPTICAL-MATERIALS AND APPLICATIONS [J].
FAINMAN, Y ;
MA, J ;
LEE, SH .
MATERIALS SCIENCE REPORTS, 1993, 9 (2-3) :53-+
[9]  
GILBERT PE, 1975, J PHARMACOL EXP THER, V192, P538
[10]   NORMORPHINE, A NEUROTOXIC METABOLITE [J].
GLARE, PA ;
WALSH, TD ;
PIPPENGER, CE .
LANCET, 1990, 335 (8691) :725-726