A reappraisal of the role of fever in the occurrence of neurological sequelae following lithium intoxication: a systematic review

Hélène Verdoux, Anne Laure Debruyne, Emmanuelle Queuille, Jose De Leon

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Introduction: We aimed to review cases of Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) characterized by neurological sequelae following acute lithium toxicity and to explore whether cerebellar sequelae are more frequent in cases presenting with fever and/or infection. Areas covered: Case reports were identified from: (i) 6 reviews published up to 2005; (ii) MEDLINE, Web of Sciences, Cochrane Library and PsycINFO search. Expert opinion: We identified 123 SILENT cases published from 1965 to 2019, in which cerebellar sequelae were observed in an overwhelming proportion (79%). SILENT may occur at any time during lithium treatment. This complication is most frequently observed during routine lithium treatment, with fewer than 10% of cases occurring after accidental or intentional overdoses. SILENT may occur even when lithium plasma levels are within the therapeutic range: 63% of cases had lithium plasma level <2.5 mEq/l (low/mild toxicity). Fever and/or infection were reported in nearly half of the patients (48%). The likelihood of presenting with cerebellar vs. other neurological sequelae was independently increased by elevated plasma lithium level (≥ 2.5 mEq/l) and by a history of fever and/or infection. Lithium users should be warned of the need to consult in case of fever to adjust their lithium dosage.

Original languageEnglish
Pages (from-to)827-838
Number of pages12
JournalExpert Opinion on Drug Safety
Volume20
Issue number7
DOIs
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • Lithium
  • adverse drug reaction
  • fever
  • infection
  • neurotoxicity

ASJC Scopus subject areas

  • Pharmacology (medical)

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