Document Detail

Acetylcholinesterase inhibition and the extrapyramidal syndrome: a review of the neurotoxicity of organophosphate.
MedLine Citation:
PMID:  11577800     Owner:  NLM     Status:  MEDLINE    
Organophosphate poisonings are not uncommon, and are the leading cause of death in suicide patients in Taiwan. Acute cholinergic crisis caused by the inhibition of synaptic acetylcholinesterase is the major manifestation of organophosphate poisoning and may cause death within minutes. Delayed neurotoxicities include intermediate syndrome and delayed polyneuropathy have also been described. However, these symptoms may not characterize the complete picture of organophosphate poisoning. Among the 633 patients ever admitted to our hospital with organophosphate poisoning, three patients were found exhibiting impermanent neuromuscular dysfunction, including blepharoclonus, oculogyric crisis, intermittent dystonia, rigidity, and tremor, with two of them developing mask face, dyskinesia and akathisia later, following acute cholinergic crisis. The symptoms appeared within 4 days with the duration ranging from 25 days to 2 months. Other causes of the extrapyramidal syndrome noted on these patients have been excluded, and we consider the extrapyramidal syndrome a possible neurotoxic manifestation of organophosphate poisoning, which is transient, needs no treatment, and may be missed because of the critical condition, in a minority of patients. The mechanism remains to be identified, but may be related to the impediment of the function of acetylcholinesterase to modify nigrostriatal dopaminergic system, which is independent of hydrolyzing acetylcholine. More detailed observation for organophosphate poisoned patients and more studies for the biological functions of acetylcholinesterase including the influence on the nigrostriatal dopaminergic system are needed.
B H Hsieh; J F Deng; J Ger; W J Tsai
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Neurotoxicology     Volume:  22     ISSN:  0161-813X     ISO Abbreviation:  Neurotoxicology     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-10-01     Completed Date:  2002-02-14     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7905589     Medline TA:  Neurotoxicology     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  423-7     Citation Subset:  IM    
Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
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MeSH Terms
Basal Ganglia Diseases / chemically induced*,  drug therapy
Cholinesterase Inhibitors / adverse effects*
Insecticides / adverse effects*
Muscarinic Antagonists / therapeutic use
Organophosphorus Compounds*
Reg. No./Substance:
0/Cholinesterase Inhibitors; 0/Insecticides; 0/Muscarinic Antagonists; 0/Organophosphorus Compounds; EC

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