Long-lasting neurological sequelae after lithium intoxication

A combined literature study and correspondence follow-up provided information about the development and further course of long-lasting neurological sequelae after lithium intoxication in 40 patients (28 women and 12 men). The circumstances surrounding the acute intoxications were examined. Possible precipitating circumstances included somatic illness with fever (11 cases), concurrent treatment with low-salt diet and diuretics, major surgery, low food intake, recent start with large lithium doses, acute overdose with suicidal intent, overdose due to pharmacy, laboratory or patient mistakes, and concurrent treatment with large doses of haloperidol in the presence of fever. In five cases no likely precipitant could be found, and in three cases there was no information about the circumstances of the acute intoxication. The neurological sequelae developed following abatement of the acute intoxication and typically showed cerebellar affection with ataxia and scanning speech. Other brain regions could be affected, and peripheral neuropathy occurred. Improvement was in some cases seen during the first 6-12 months, supported psychologically and perhaps also functionally by physiotherapy, speech therapy, and general rehabilitation. The paper ends with a discussion of measures and guidelines to prevent the development of intoxications and permanent neurological sequelae. An Appendix provides warnings and precautions.