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Letters to the Editor
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Pharmacology
Convulsions puzzle
From Mr A. C. Carter, MRPharmS
Would any colleague be able to throw light on the following unsolved
problem?
A young woman suffering from fibromyalgia was prescribed hydroxychloroquine
and amitriptyline by her GP. With her GP’s consent, she attended
a private fibromyalgia clinic where she received trigger-point injections
of lignocaine, plus magnesium and Pabrinex. The consultant recommended
that she discontinue the medication prescribed by her GP, which she elected
to do abruptly rather than gradually.
Two weeks later, she returned to the clinic and the injections were repeated.
Five hours later she collapsed and was admitted to hospital with convulsive
episodes, which continued with varying severity for two weeks. Exhaustive
tests at the hospital found no organic abnormalities and she was discharged.
Since no cause has been found for these convulsions, is any reader able
to offer any plausible pharmacological hypothesis to account for them?
This might possibly involve some form of delayed neurotransmitter surge
following tricyclic antidepressant cessation, or the production of a
super-sensitivity state in the skeletal muscle receptors.
Anthony Charles Carter
Paignton, Devon
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Pharmaceutical Journal