Evidence map›Paper›PMID 31143451›Full record

ArticleCerebellum & ataxias2019

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

Ptolemaios Georgios Sarrigiannis, Panagiotis Zis, Zoe Charlotte Unwin, Daniel J Blackburn, Nigel Hoggard, Yifan Zhao, Stephen A Billings, Aijaz A Khan, John Yianni, Marios Hadjivassiliou

Open access · hybridAbstract readCase Reports
In one paragraph

Article in Cerebellum & ataxias, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Drug-Induced Myoclonus: A Systematic Review.Medicina (Kaunas, Lithuania) · 2025
    Pooled it
  2. Article
  3. Article
  4. Spectral Analysis of Lithium Tremor.Noro psikiyatri arsivi · 2021
    Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Ptolemaios Georgios Sarrigiannis1Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Floor N., Sheffield, UK.ORCID 0000-0002-8380-8755
Panagiotis Zis1Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Floor N., Sheffield, UK.
Zoe Charlotte Unwin1Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Floor N., Sheffield, UK.
Daniel J Blackburn2Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Nigel Hoggard3Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Yifan Zhao4Through-life Engineering Services Centre, Cranfield University, Bedford, MK43 0AL UK.
Stephen A Billings5Department of Automatic Control and Systems Engineering, University of Sheffield, S1 3JD, Sheffield, UK.
Aijaz A Khan2Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
John Yianni6Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Marios Hadjivassiliou2Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust · GBRoyal Hallamshire Hospital · GBCranfield University · GBUniversity of Sheffield · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTremor is a common side effect of treatment with lithium. Its characteristics can vary and when less rhythmical, distinction from myoclonus can be difficult.

methodsWe identified 8 patients on long-term treatment with lithium that developed upper limb tremor. All patients were assessed clinically and electrophysiologically, with jerk-locked averaging (JLA) and cross-correlation (CC) analysis, and five of them underwent brain MRI examination including spectroscopy (MRS) of the cerebellum.

resultsSeven patients (6 female) had action and postural myoclonus and one a regular postural and kinetic tremor that persisted at rest. Mean age at presentation was 58 years (range 42-77) after lengthy exposure to lithium (range 7-40 years). During routine monitoring all patients had lithium levels within the recommended therapeutic range (0.4-1 mmol/l). There was clinical and/or radiological evidence (on cerebellar MRS) of cerebellar dysfunction in 6 patients. JLA and/or CC suggested a cortical generator of the myoclonus in seven patients. All seven were on antidepressants and three additionally on neuroleptics, four of them had gluten sensitivity and two reported alcohol abuse.

conclusionsA synergistic effect of different factors appears to be contributing to the development of cortical myoclonus after chronic exposure to lithium. We hypothesise that the cerebellum is involved in the generation of cortical myoclonus in these cases and factors aetiologically linked to cerebellar pathology like gluten sensitivity and alcohol abuse may play a role in the development of myoclonus. Despite the very limited evidence in the literature, lithium induced cortical myoclonus may not be so rare.

Indexed as

Cerebellar ataxiaCortical myoclonusGluten sensitivityJLALithiumMRS

Identifiers

PMID31143451
PMCPMC6532190
OpenAlexW2947787252

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.