Lithium-induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy?
Lithium therapy can cause a confusional state by direct toxicity, precipitation of nonconvulsive status epilepticus, or by interplay with other neuroleptic medications to produce neuroleptic malignant syndrome or serotonin syndrome. These conditions resemble each other clinically, but EEG may help differentiate among them. We reviewed the EEG patterns with triphasic waves or rhythmic delta activity in lithium toxic patients and discuss clinical and EEG differentiation among syndromes. Lithium toxicity poses significant diagnostic challenges from EEG and clinical perspectives.
Kaplan
Peter W
PW
Department of Neurology, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore, Maryland 21224, USA. pkaplan@jhmi.edu
Birbeck
Gretchen
G
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D003221:Confusion / Q000139:chemically induced* / Q000175:diagnosis*; D003700:Delta Rhythm / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D004347:Drug Interactions; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000209:etiology; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D020230:Serotonin Syndrome / Q000139:chemically induced / Q000175:diagnosis; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis*
D014150:Antipsychotic Agents; D018020:Lithium Compounds