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Table 1 Electroclinical and neuroimaging findings

From: Tremor after long term lithium treatment; is it cortical myoclonus?

Case no Age at onset (Gender) Years on lithium Gluten sensitivity Cerebellar MRS JLA & CCc SEPs Postural tremore frequency Psychotropic medication daily doses
1 77y, F 40y Reduced NAA/Cr a
vermis 0.91
hemispheres 0.78
Action and stimulus reflex cortical myoclonus “Giant” & C-reflexes b 14 Hz Lithium d 400 mg
Mirtazapine 45 mg
2 63y, F 10y + IgG Reduced NAA/Cr
vermis 0.87
hemispheres 1.04
Cortical myoclonus normal 10 Hz Lithium 400 mg
Mirtazapine 45 mg
Sertraline 200 mg
3 57y, M 7y + IgG Reduced NAA/Cr
vermis 0.79
hemispheres 1.04
Cortical myoclonus normal 10 Hz Lithium 408 mg
Venlafaxine 225 mg
4 47y, F 10y Reduced NAA/Cr
vermis 0.75
hemispheres 0.8
Cortical myoclonus normal 11 Hz Lithium 800 mg
imipramine 100 mg
Olanzapine 25 mg
5 55y, F 30y + IgG Reduced NAA/Cr
vermis 0.89
hemispheres 0.85
Cortical myoclonus normal 10 Hz and first harmonic at 20 Hz Lithium 675 mg
Citalopram 40 mg
Quetiapine 100 mg
6 70y, F 20y + IgG ND Cortical myoclonus normal 8 Hz Lithium 400 mg
fluoxetine 40 mg
7 42y, F 10y ND Cortical myoclonus normal 13 Hz Lithium 1000 mg
Quetiapine 650 mg
Sertraline 100 mg
8 66y, M 29y ND Central tremor normal 6 Hz and first harmonic at 12 Hz Lithium 800 mg
Flupenthixole 0.5 mg
  1. MRS Magnetic resonance spectroscopy, ND not done, SEP somatosensory evoked potentials
  2. aThe NAA/Cr, N-acetyl-aspartate/creatine. This was measured in the vermis and cerebellar hemispheres (normal values Vermis > 0.95, hemispheres > 1.00
  3. bThe P1N2 and the P1N3 components were enlarged, above 14 μV (Fig. 1b)
  4. cJLA, jerk locked averaging and CC, cross correlation analysis were applied in cases 1–8, results are shown in Figs. 1, 2, 3 and 4
  5. dAll patients had lithium serum levels within the normal range: 0.4-1 mmol/L and all received a dose below 1200 mg/die of lithium carbonate or equivalent dose of lithium citrate (liquid preparation)
  6. eCases 1 to 7 presented with a quasi-regular tremor while case 8 was rhythmical. Frequencies were estimated with the in-built FFT function in spike 2 software on 20 s epochs of EMG recordings during upper limb maintenance of anti-gravity posture