ABSTRACT
Mujer de 54 años de edad estudiada por debilidad crónica, atrofia muscular y elevación de creatin Kinshasa en sangre. El EMG de musculatura proximal de miembros superiores e inferiores reveló se registraron numerosas descargas repetitivas de potenciales de unidad motora polifásicos con amplitudes y frecuencias de disparo constantes, estaban integradas por 6 potenciales de fibra simple con un jitter entre sus diferentes componentes inferior a 5 µseg. Que sepamos, no han sido descritas descargas repetitivas complejas de estas características en miopatías mitocondriales del hombre, aunque si han sido referidas en el perro
A 54 year old woman was studied in our lab because chronic weakness, limb-girdle muscular atrophy and increased blood CK level. Electromyography assessment of proximal muscles in arms and legs revealed complex repetitive discharges with a very low interpotential jitter lesser than 5 µseg, further indicating the absence of end plate activity in their causation. Then, they are thought to originate form spontaneous activity in a single muscle fiber which activates one or more adjacent muscle fibre ephaptically. Ephaptic transmission from fibre to fibre in skeletal muscle is ordinarily prevented by the absence of adjacent simultaneously depolarizing muscle fibres, because of the pseudorandom nature of the distribution of the motor unit. When this relation is disturbed by reorganization of the motor unit in neurogenic and, to a lesser extent, in cronic myopathic diseases, cross-firing of adjacent muscle fibres is more likely. In our knowledge, this is the first time that complex repetitive discharges have been found in a human mitochondrial myopathic although they have been yet reported in sheepdog littermates
Subject(s)
Humans , Female , Middle Aged , Mitochondrial Myopathies/physiopathology , Electromyography , Muscular Atrophy/physiopathology , Neurophysiology/methodsABSTRACT
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Subject(s)
Aged , Male , Female , Humans , Hospital Mortality , Primary Health Care , Cause of Death , Medical RecordsABSTRACT
INTRODUCTION: Zolpidem is derived from imidazopiridine. In recent years it has been used as a non benzodiazepine hypnotic. It is a short acting inducer of sleep of similar efficacy to the benzodiazepines or zopiclone, but well tolerated and does not lead to drug abuse, rebound effects or abstinence syndromes. In this clinical note we wish to show that in spite of the descriptions in the medical literature, complications may follow long term use of zolpidem. CLINICAL CASE: We report the case of a 50 year old woman with no clinical history of interest apart from chronic insomnia and anxiety. She had been treated with zolpidem for the previous five years, at the usual dosage. However, since this seemed to be insufficient, the dose was progressively increased until in the months before she was seen by us she was taking a total of 450 mg per day in divided doses. She had drug tolerance, abuse and dependence. After a period of 12 hours without taking zolpidem she developed an abstinence syndrome, with generalized tonic clonic seizures and a prolonged post convulsion period which improved on symptomatic anticonvulsant treatment. CONCLUSIONS: In view of our case, and others described, we should be sceptical of the claim that zolpidem has no side effects, since it may give rise to tolerance, abuse and an abstinence syndrome. We consider that its indiscriminate use should be modified. Patients should be carefully followed up and medical prescription necessary to obtain zolpidem, as opposed to its current unrestricted availability.
Subject(s)
Epilepsy/etiology , GABA Agonists/adverse effects , Pyridines/adverse effects , Substance Withdrawal Syndrome/etiology , Drug Administration Schedule , Electroencephalography , Epilepsy/diagnosis , Female , GABA Agonists/administration & dosage , Humans , Pyridines/administration & dosage , Severity of Illness Index , ZolpidemABSTRACT
Introducción. El zolpidem es un derivado de la imidazopiridina, empleado en los últimos años como hipnótico no benzodiacepínico; es un inductor del sueño de acción corta, con eficacia similar a otros, como las benzodiacepinas o zopiclona, pero con buena tolerancia, sin producir abuso, efecto rebote ni síntomas de abstinencia. Con esta nota clínica queremos manifestar que, pese a lo descrito en la literatura médica, existen complicaciones por consumo crónico de zolpidem. Caso clínico. Describimos el caso de una mujer de 50 años de edad, sin antecedentes de interés, salvo insomnio crónico y ansiedad, en tratamiento con zolpidem desde hace más de 5 años en dosis habituales; pero, ante la falta de eficacia, aumentó progresivamente la ingesta hasta que en los últimos meses consumía 450 mg/día en varias tomas, y presentó tolerancia, abuso y dependencia. Tras un período de 12 horas sin ingesta, presentó síndrome de abstinencia, con crisis generalizadas tonicoclónicas y período poscrítico prolongado, que revertieron con tratamiento sintomático anticomicial. Conclusiones. De acuerdo con nuestro caso, y otros descritos, deberíamos dudar de la falta de efectos secundarios al emplear zolpidem, por su tolerancia, potencial de abuso y síndrome de abstinencia. Pensamos que se debe moderar el empleo indiscriminado de esta sustancia y realizar un seguimiento estrecho de los pacientes en tratamiento, con la inclusión de la obligatoriedad de prescripción facultativa, ya que hasta ahora se puede adquirir sin necesidad de receta médica (AU)
