Mercury toxicity following unauthorized siddha medicine intake – A mimicker of acquired neuromyotonia - Report of 32 cases

作者：G Gnanashanmugam, R Balakrishnan, SP Somasundaram, Narayanasamy Parimalam, Priyanka Rajmohan, MB Pranesh · 发表于：Annals of Indian Academy of Neurology · 年份：2018 · DOI：10.4103/aian.aian_274_17 · 被引用次数：25 · 研究领域：Mercury impact and mitigation studies、Heavy Metal Exposure and Toxicity、Phytochemicals and Medicinal Plants

CONTEXT: Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. SUBJECTS AND METHODS: This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. RESULTS: Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. CONCLUSIONS: Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia...