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1/11. "Herbal Ecstasy": a case series of adverse reactions.

    AIMS: To report five cases of adverse effects associated with the ingestion of "Herbal Ecstasy" tablets and discuss possible mechanisms of toxicity. METHOD: Composition of the "Herbal Ecstasy" tablets was determined by discussions with distributors and with MEDSAFE: Reference to relevant texts and an internet and medline literature search was used to identify articles of interest RESULTS: Three patients complained of minor symptoms such as perceptual disturbances, anorexia, inability to sleep, dizziness, palpitations and paresthesia. A fourth patient presented with palpitations and ventricular bigeminy, and a fifth patient presented with headache, vomiting, and a hypertensive crisis. Different brands of "Herbal Ecstasy" have different compositions, some containing caffeine and kava, and one contained ephedrine. CONCLUSION: These five patients presented with adverse reactions to "Herbal Ecstasy" ranging from minor to major. knowledge of the possible mechanisms of toxicity will help plan therapy in cases of major toxicity.
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keywords = headache
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2/11. amyotrophic lateral sclerosis associated with insomnia and the aggravation of sleep-disordered breathing.

    A case of amyotrophic lateral sclerosis (ALS) diagnosed by sleep-disordered breathing is described. The patient's chief complaints were insomnia and nocturnal dyspnea after taking a hypnotic drug. On examination, he showed restrictive ventilatory impairment, alveolar hypoventilation and hypoxia. Polysomnographic examination revealed marked hypoxia during REM sleep periods, decreased duration of REM sleep periods, and increased sleep disruption. amyotrophic lateral sclerosis was diagnosed by the neurological finding of paraspinal muscle weakness and neurogenic changes revealed by needle electromyography and muscle biopsy. The daytime and nocturnal respiratory insufficiency improved after nasal bilevel positive airway pressure therapy. amyotrophic lateral sclerosis should be suspected as a cause of insomnia and nocturnal dyspnea.
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ranking = 72.406482258758
keywords = breathing
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3/11. Relapsing-remitting autoimmune agrypnia.

    A woman affected by multiple cranial nerve palsy developed several episodes of total insomnia and respiratory crises resulting from central breathing depression associated with dysautonomic symptoms. Oligoclonal IgG bands were present in her cerebrospinal fluid, and immunohistochemistry showed increased binding of serum and cerebrospinal fluid on gamma-aminobutyric acid-ergic, synapse-rich neuronal cells. Immunosuppressive treatment and plasma exchange were followed by clinical improvement, with restoration of sleep architecture and disappearance of respiratory crises, suggesting autoimmune pathogenesis of the syndrome.
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ranking = 14.481296451752
keywords = breathing
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4/11. Zolpidem-induced distortion in visual perception.

    OBJECTIVE: To describe a patient who developed visual perception distortion after a single dose of zolpidem. CASE SUMMARY: A 50-year-old Asian woman had been prescribed conjugated estrogen 1 tablet daily for hormone replacement therapy and tricalcium phosphate twice daily for osteoporosis. One day, she took zolpidem 10 mg for insomnia as well as acetaminophen 500 mg for headache at bedtime and began to have visual perception distortion (e.g., the shapes of objects were twisted, houses were crooked) within 20 minutes, lasting for approximately 30 minutes, and then her vision returned to normal. She only partially recalled the event. She had never taken zolpidem before, and she had not had any such disturbances in the past. DISCUSSION: There have been 21 case reports of zolpidem-related psychotic symptoms in the literature; however, the exact mechanism by which zolpidem may cause visual perception changes is undetermined. Many factors have been correlated with zolpidem-induced visual experiences, such as pharmacokinetic factors, gender, age, and hypoalbuminemia. This patient shared certain similarities such as gender, dosage, and time of onset and duration of adverse reactions. CONCLUSIONS: An objective causality assessment revealed that the zolpidem-induced visual perception distortion in this patient was probable. Clinicians should be aware of the potential for visual perception distortion, as this is an uncommon adverse effect.
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keywords = headache
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5/11. Effects of Yoku-kan-san on undifferentiated somatoform disorder with tinnitus.

    Up to the present, there have been few strategies that are completely effective in treating undifferentiated somatoform disorder with tinnitus. We herein report that Yoku-kan-san (TJ-54), one of japan's traditional herbal medicines, is an effective treatment for tinnitus in undifferentiated somatoform disorder complicated with headache and insomnia. TJ-54 has been also used as an effective treatment for insomnia and irritability in recent centuries and is considered to have some effects on the excitability of nerves. Further studies are needed to confirm the efficacies of Japanese herbal medicines.
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keywords = headache
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6/11. Insomnia and its treatment. When are hypnotics justified?

    Symptomatic treatment of transient insomnias is advisable, for without treatment these sleep disorders may become persistent. The drugs of choice are the benzodiazepine hypnotics, which have minimal side effects when used for short periods in properly selected patients. The three such drugs currently available in the united states differ enough in half-life, absorption rate, and potential for drug interactions that they cannot be used interchangeably. A sound selection matches the drug's characteristics with the patient's needs. Transient insomnias must be differentiated from persistent insomnias, which are more resistant to treatment. Hypnotic agents not only are more likely to be ineffective against persistent insomnias but also have greater potential for exacerbating a sleep-related breathing disorder, producing a drug-dependent insomnia, or contributing to drug misuse.
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ranking = 14.481296451752
keywords = breathing
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7/11. Sleep disturbances in a case of brain-stem lesions; pharmacological study.

    A pharmacological study was carried out of a case of severe insomnia following brain-stem lesions; several polygraphic controls were used. Initially total duration of sleep was brief (less than 4 h) with a high REM/NREM ratio and a short paradoxical sleep (PS) latency. In addition, periodic breathing and tremor were observed. Slow injection of delta-sleep-inducing peptide (DSIP) improved sleep both quantitatively and qualitatively, although PS latency remained short. These effects were reversible. The effects of 5-HTP benzerazide, of L-DOPA benzerazide (Modopar) and of clonazepam (Rivotril) were compared.
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ranking = 14.481296451752
keywords = breathing
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8/11. Psychological symptoms and intermittent hypertension following acute microwave exposure.

    Two men who were accidentally, acutely irradiated with X-band microwave radiation have been followed up clinically for 12 months. Both men developed similar psychological symptoms, which included emotional lability, irritability, headaches, and insomnia. Several months after the incidents, hypertension was diagnosed in both patients. No organic basis for the psychological problems could be found nor could any secondary cause for the hypertension. A similar syndrome following microwave exposure has been described by the East Europeans. The two cases we report, with comparable subjective symptoms and hypertension following a common exposure, provide further strong, circumstantial evidence of cause and effect. A greater knowledge of the mechanisms involved in bioeffects which may be induced by radiofrequency and microwave radiation is definitely needed.
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ranking = 1
keywords = headache
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9/11. Transient recurrent situational insomnia associated with cluster headache.

    Headache syndromes are known to occur in association with sleep. Both the clinical and the polysomnographic abnormalities occurring in association with various headache syndromes have been described. We report the occurrence of transient recurrent situational insomnia that occurred in association with chronic cluster headaches and was reversible after the headache cluster subsided. This seems to represent a further degree of sleep disturbance in addition to the previously described insomnia and other abnormal polysomnographic features that may occur in direct association with the headache syndromes.
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ranking = 8
keywords = headache
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10/11. Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable.

    BACKGROUND: Forty four individuals, suffering from temporary insomnia and poor appetite followed by progressive difficulty breathing after four weeks or more ingestion of the Sauropus androgynus or Sabah vegetable, were reported to the National Poison Center of taiwan by physicians between August 23, 1994 and August 25, 1995. OBJECTIVE: A telephone questionnaire survey was designed and conducted to collect demographic data, information about use of the vegetable, past medical history and clinical presentation. Laboratory data were obtained from their physicians as available. RESULTS: Forty one patients, predominantly women, 43 /- 11 years old, were identified in our survey. They reported a variety of sources and preparation methods for the vegetable. Difficulty breathing, identified in 36 cases, was the clinical hallmark. Twenty people gave a history of dyspnea delayed until 44 /- 40 days after discontinuing vegetable consumption. Laboratory evidence of obstructive ventilatory impairment (FEV1/FVC 56 /- 12%, FEV1 31 /- 6%, PaO2 71 /- 15%) was observed in 12 cases tested. An open lung biopsy performed in a demonstration case disclosed bronchiolitis obliterans organizing pneumonia. CONCLUSION: In this case series of 41 victims, we have identified a severe pulmonary effect and hypothesize that it is related to consumption of sauropus androgynus vegetable. papaverine has been previously identified in this vegetable but is unlikely to be responsible for the full range of toxicity seen.
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ranking = 28.962592903503
keywords = breathing
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