Benzodiazepines are commonly used medications which are clinically useful towards the treatment of alcohol withdrawal, seizures, anxiety disorders, among other indications. Benzodiazepine use is also known to cause the rare phenomenon of paradoxical excitation whose mechanism has many postulated theories. We report this rare presentation of paradoxical excitation with the use of lorazepam in a 50-year-old male being treated for alcohol withdrawal. We also review the underlying pathophysiology, pharmacology, and current literature as it relates to this excitation. An inability to recognize this adverse effect and to appropriately withhold the agent may adversely affect a patient's course of treatment in the inpatient setting.
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http://dx.doi.org/10.1177/08971900221097182 | DOI Listing |
Fentanyl is a potent synthetic opioid widely used perioperatively and illicitly as a drug of abuse . It is well established that fentanyl acts as a μ-opioid receptor agonist, signaling through Gα intracellular pathways to inhibit electrical excitability, resulting in analgesia and respiratory depression . However, fentanyl uniquely also triggers muscle rigidity, including respiratory muscles, hindering the ability to execute central respiratory commands or to receive external resuscitation.
View Article and Find Full Text PDFBiophys J
January 2025
Department of Pharmacology, University of California Davis, California 95616.
In every heartbeat, cardiac muscle cells perform excitation-Ca signaling-contraction (EC) coupling to pump blood against the vascular resistance. Cardiomyocytes can sense the mechanical load and activate mechano-chemo-transduction (MCT) mechanism, which provides feedback regulation of EC coupling. MCT feedback is important for the heart to upregulate contraction in response to increased load to maintain cardiac output.
View Article and Find Full Text PDFLoss-of-function (LOF) mutations in KATP channels cause hyperexcitability and insulin hypersecretion, resulting in congenital hyperinsulinism (CHI). Paradoxically, despite the initial insulin hypersecretion, many CHI cases, as well as KATP knockout (KO) animals, eventually 'crossover' to undersecretion and even diabetes. Here we confirm that Sur1 KO islets exhibit higher intracellular [Ca2+] ([Ca2+]i) at all [glucose], but show decreased glucose-stimulated insulin secretion.
View Article and Find Full Text PDFEpilepsia
December 2024
Shanghai Pudong Hospital, Fudan University Pudong Medical Center, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science and Institutes of Brain Science, Fudan University, Shanghai, China.
Objective: The piriform cortex (PC) plays a critical role in ictogenesis, where an excitation/inhibition imbalance contributes to epilepsy etiology. However, the epileptic dynamics of the gamma-aminobutyric acid (GABA) system and the precise role of GABAergic neurons within the PC in epilepsy remain unclear.
Methods: We combined Ca and GABA sensors to investigate the dynamics of Gad2-expressing neurons and GABA levels, and selectively manipulated GABAergic neurons in the PC through chemogenetic inhibition and caspase3-mediated apoptosis targeting Gad2 interneurons.
ArXiv
November 2024
Laboratoire de Neurosciences Cognitives et Computationnelles, INSERM U960.
Networks of excitatory and inhibitory (EI) neurons form a canonical circuit in the brain. Seminal theoretical results on dynamics of such networks are based on the assumption that synaptic strengths depend on the type of neurons they connect, but are otherwise statistically independent. Recent synaptic physiology datasets however highlight the prominence of specific connectivity patterns that go well beyond what is expected from independent connections.
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