Blijvende neurologische schade bij therapeutische lithiumconcentraties in het plasma

- A woman aged 72 who because of a bipolar manic depressive psychosis had for over 20 years been treated with lithium (often combined with neuroleptics), was admitted as an emergency case because of a neurotoxic condition characterized by organic psychopathological symptoms, pyramidal and extrapyramidal signs and fever. The plasma lithium levels three days before admission and at admission were low-therapeutic, viz. 0.80 and 0.53 mmoll, respectively.

This form of neurotoxicity was described for the first time in 1974 by Cohen and Cohen, who attributed it to the combination of lithium and neuroleptics. Our patient used lithium carbonate and thioridazine, and later, lithium and haloperidol. The neurotoxic condition was not recognized at first, so that lithium treatment was only discontinued after three weeks. After cessation of both medications an irreversible extrapyramidal syndrome persisted without cognitive deterioration. This case appears to confirm the interaction between lithium and neuroleptics postulated by Cohen and Cohen.