title: Neurologic sequelae of domoic acid intoxication due to the ingestion of contaminated mussels.
abstract: In late 1987 there was an outbreak in Canada of gastrointestinal and neurologic symptoms after the consumption of mussels found to be contaminated with domoic acid, which is structurally related to the excitatory neurotransmitter glutamate. We studied the neurologic manifestations in 14 of the more severely affected patients and assessed the neuropathological findings in 4 others who died within four months of ingesting the mussels. In the acute phase of mussel-induced intoxication, the patients had headache, seizures, hemiparesis, ophthalmoplegia, and abnormalities of arousal ranging from agitation to coma. On neuropsychological testing several months later, 12 of the patients had severe anterograde-memory deficits, with relative preservation of other cognitive functions. Eleven patients had clinical and electromyographic evidence of pure motor or sensorimotor neuronopathy or axonopathy. Positron-emission tomography of four patients showed decreased glucose metabolism in the medial temporal lobes. Neuropathological studies in the four patients who died after mussel-induced intoxication demonstrated neuronal necrosis and loss, predominantly in the hippocampus and amygdala, in a pattern similar to that observed experimentally in animals after the administration of kainic acid, which is also structurally similar to glutamate and domoic acid. We conclude that intoxication with domoic acid causes a novel and distinct clinicopathologic syndrome characterized initially by widespread neurologic dysfunction and then by chronic residual memory deficits and motor neuronopathy or axonopathy.
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Teitelbaum
authors.forename: R J
authors.initials: RJ
authors.lastname: Zatorre
authors.forename: S
authors.initials: S
authors.lastname: Carpenter
authors.forename: D
authors.initials: D
authors.lastname: Gendron
authors.forename: A C
authors.initials: AC
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Gjedde
authors.forename: N R
authors.initials: NR
authors.lastname: Cashman
mesh_terms: D000818:Animals; D049872:Bivalvia; D001921:Brain / Q000378:metabolism; D004196:Disease Outbreaks; D004576:Electromyography; D005506:Food Contamination; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007608:Kainic Acid / Q000031:analogs & derivatives* / Q000506:poisoning; D008387:Marine Toxins / Q000506:poisoning*; D008569:Memory Disorders / Q000139:chemically induced; D009046:Motor Neurons; D009207:Myoclonus / Q000139:chemically induced; D009336:Necrosis; D009422:Nervous System Diseases / Q000139:chemically induced; D009468:Neuromuscular Diseases / Q000139:chemically induced; D018377:Neurotransmitter Agents / Q000506:poisoning*; D011325:Prince Edward Island; D012640:Seizures / Q000139:chemically induced; D013702:Temporal Lobe / Q000378:metabolism; D014055:Tomography, Emission-Computed
chemical_list: D008387:Marine Toxins; D018377:Neurotransmitter Agents; D005947:Glucose; C012301:domoic acid; D007608:Kainic Acid