Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk,...
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Transcript of Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk,...
![Page 1: Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk, MD, Loma Linda University Medical Center, Loma Linda,](https://reader035.fdocuments.in/reader035/viewer/2022062515/56649c955503460f94952d31/html5/thumbnails/1.jpg)
Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA
Brian J. Wolk, MD, Loma Linda University Medical Center, Loma Linda, CA
Yo! GABA GABA and Other Key Players in "Natural" Seizures
![Page 2: Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk, MD, Loma Linda University Medical Center, Loma Linda,](https://reader035.fdocuments.in/reader035/viewer/2022062515/56649c955503460f94952d31/html5/thumbnails/2.jpg)
Objectives:
Appreciate the variety of mechanisms of natural toxin-induced seizures and how they interact
Be able to visually identify at least 5 natural toxins causing seizures
Be able to describe the mechanism of seizures in at least 5 natural toxins
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Disclosures:
Dr. Wolk is a Co-investigator for Analatro (Black Widow Fab2 Antivenom)-Instituto Bioclon/Rare Disease Therapeutics
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Help, I just had a seizure in my
hand!
100
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500
Horrible Herbs
100
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300
400
500
Yo! GABA GABA
100
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300
400
500
Look-a-likes
100
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400
500
That wasn’t a seizure; that was
a dance move
100
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500
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Category 1 questions follow
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Quest
ion
The primary mechanism of the toxin found in this substance.
100Category 1
http://www.flickr.com/photos/bonjourwill/4528624762/sizes/o/
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Answ
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Adenosine receptor antagonism
100Category 1
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Quest
ion
Rick James may have used a certain substance derived from this plant:
200Category 1
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Answ
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Coca Plant
200Category 1Coca Picture Refernce: http://upload.wikimedia.org/wikipedia/commons/7/72/Colcoca04.jpg
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Quest
ion
This plant native to Southeast Asia:
Hint: commonly used to ‘stun’ fish
300Category 1
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Answ
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Plant: Anamirta cocculus or Fishberries
300Category 1Picture Reference: http://upload.wikimedia.org/wikipedia/commons/7/70/Anamirta_cocculus_02.JPG
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Quest
ion
This toxin is derived from a large tree with broad-leaves.
It is native to China and Japan, but is considered an invasive species in the Southern United States.
400Category 1
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Answ
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Camphor
400Category 1
http://plants.ifas.ufl.edu/misc/reco_cards/cincam.pdf
http://i00.i.aliimg.com/photo/v0/105180782/Camphor_Bulk.jpg
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Quest
ion
Latin name for the genus, toxin and mechanism of toxicity:
500Category 1
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Answ
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Aconitum, Aconitine, & Sodium-Channel Blockade
Also known as Wolfsbane or Monskhood
500Category 1
Picture Reference: http://upload.wikimedia.org/wikipedia/commons/7/70/Aconitum_napellus_Ticino.jpg
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Category 2 questions follow
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Quest
ion
Plant and mechanism of action of its toxin:
100Category 2
http://farm9.staticflickr.com/8301/7808736868_5ce5abf011_b.jpg Creative Commons License
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Answ
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Tobacco/Nicotinic
100Category 2
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Quest
ion
This bane of livestock is terribly toxic.
200
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Answ
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Cowbane or Cicuta Virosa
200Category 2
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Quest
ion
This edible ‘pea’ contains the neurotoxin ẞ-N-oxalylamino-L-alanine (BOAA) which is a glutamate agonist
300Category 2
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Answ
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Lathyrus Sativa (Chickling Pea)
300Category 2
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Quest
ion
This fall flower may give you seizures, but that could be the least of your problems:
400Category 2
http://s0.geograph.org.uk/photos/54/59/545962_fd7cb876.jpg“© Copyright Evelyn Simak and licensed for reuse under this Creative Commons Licence.”
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Answ
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Colchicum autumnale/autumn crocus (Colchicine)
400Category 2
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Quest
ion
This relative of water hemlock from the island of Sardinia may give you a Sardonic Grin:
500Category 2
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Answ
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Oenanthe fistulosa (Water Dropwort)
500Category 2
http://commons.wikimedia.org/wiki/File:Illustration_Oenanthe_aquatica0.jpg
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Category 3 questions follow
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Quest
ion
How does cocaine cause seizures?
100Category 3
http://farm3.staticflickr.com/2190/2170100460_2094dd2d6d_o.jpg
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Answ
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Adrenergic/Sympathomimetic stimulation
100Category 3
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Quest
ion
The antidote for ingestion of this savory shroom:
200Category 3
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Answ
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Pyridoxine
-Gyromitrin metabolized to Monomethylhydrazine
200Category 3
Picture Reference: http://upload.wikimedia.org/wikipedia/commons/9/97/Fr%C3%BChjahrslorchel.JPG
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Quest
ion
300Category 3
Before Redbull and Vodka, you could get your uppers &
downers from a drink made with this plant:
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Answ
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Artemisia absinthium or Wormwood
300Category 3Picture Reference: http://upload.wikimedia.org/wikipedia/commons/f/f5/Artemisia_absinthium_0002.JPG
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Quest
ion
400Category 3
Mechanism of this toxin found in mussels; linked to severe permanent neurologic damage and the deaths of > 400 Sea Lions:
http://cleanfish.com/system/images/BAhbB1sHOgZmIjsyMDExLzAzLzIxLzE2LzUwLzMyLzMxMS9TYWx0U3ByaW5nX011c3NlbHNfV2hvbGVfOC5qcGdbCDoGcDoKdGh1bWIiDTQ1MHg0NTA+/SaltSpring_Mussels_Whole_8.jpg
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Answ
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Glutamate Analogue/NMDA Agonist
400Category 3Picture Reference: Figure 1 in Teitelbaum JS, Zatorre RJ, Carpenter S, Gendron D, Evans AC, Gjedde A, et al. Neurologic sequelae of domoic acid intoxication due to the ingestion of contaminated mussels. The New England journal of medicine. 1990;322(25):1781-7.
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Quest
ion
The toxin and mechanism, respectively, of Anamirta cocculus
500Category 3
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Answ
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Toxin: Picrotoxin
Mechanism:GABA inhibitor (non-competitive)
May also inhibit glycine receptors
500Category 3
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Category 4 questions follow
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Quest
ion
Socrates did NOT eat this:
100Category 4
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Answ
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Cicuta Maculata (Water Hemlock)
100Category 4Picture Reference: http://www.illinoiswildflowers.info/wetland/photos/wt_hemlock1.jpg
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Quest
ion
This “false” fungus may be “tasty” but ingestion is inadvisable
200Category 4
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Answ
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Gyromitra Esculenta or the False Morel
200Category 4
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Quest
ion
The flowers of this plant may resemble the pants of a person from a Northern European country; this plant may also cause seizures in livestock:
300Category 4
http://farm5.staticflickr.com/4015/4525160667_8fb31c049c_b.jpg Creative Commons License
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Answ
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Dicentra cucullaria/Dutchman's breeches
Toxin: Bicuculline
300Category 4
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Quest
ion
This bad actor causes seizures less frequently than its cousin, and may be identifiable by its coloration:
400Category 4
http://farm1.staticflickr.com/208/508080682_a19188ceb5_o.jpg Creative Commons License
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Answ
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Conium maculatum or Poison Hemlock
400Category 4
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Quest
ion
This stellate assassin is sometimes mistaken for its benign Chinese cousin:
500Category 4
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Answ
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Illicium anisatum/Japanese star anise (Anisatin)
-non-competitive GABA (channel) inhibition
500Category 4Picture Reference: http://2.bp.blogspot.com/_a5abCT2isic/TBl3SSBhWQI/AAAAAAAACwM/P63cuGW_gzc/s400/star_anise.jpg
http://upload.wikimedia.org/wikipedia/commons/6/62/Illicium_verum_2006-10-17.jpg
For comparison: Illicium verum or
Chinese Star Anise (Non-toxic)
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Category 5 questions follow
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Quest
ion
The NMDA agonist in this fungus theoretically could causes seizures, but rarely does due to it’s concomitant CNS depressant
100Category 5
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Answ
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Amanita Muscaria or Fly agaric
100Category 5
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Quest
ion
200Category 5
The name of the NMDA agonist in this mushroom:
http://s0.geograph.org.uk/geophotos/02/12/31/2123114_83948608.jpg
“© Copyright JamesB and licensed for reuse under this Creative Commons Licence.”
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Answ
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Ibotenic Acid
200Category 5
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Quest
ion
Chew on this, and you might get a little rush:
300Category 5
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Answ
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Qat or Khat (Cathinones)
300Category 5
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Quest
ion
Found in some traditional remedies, this toxin may give you a convulsion to remember
400Category 5
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Answ
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Strychnos Nux Vomica or
Strynchine
400Category 5
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Quest
ion
Specific mechanism by which this cellular asphyxiant may cause seizures (other than general cellular asphyxia):
500Category 5
http://upload.wikimedia.org/wikipedia/commons/9/9e/Autumn_Red_peaches.jpg
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Answ
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Glutamic Acid Decarboxylase Inhibition
500Category 5