PDF(Pubmed)
Abstract：
The Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) is a rare but concerning neurological complication resulting from lithium intoxication. Despite being reported since the 1960s, SILENT remains poorly understood and previous reviews on this topic commonly have been narrative. We therefore conducted a scoping review to assess the nature and scope of the research literature on the long-term neurological sequelae of lithium toxicity and determine the current knowledge of SILENT. A comprehensive and systematic literature search, using the MEDLINE, Embase, and Web of Science databases (from inception to July 2023), was conducted for English and Dutch articles, assessing the long-term neurological sequelae of lithium intoxication. Key information concerning clinical manifestations, risk factors, therapeutic approaches, or preventive measurements was extracted. We reviewed 91 articles, extracting information from 117 cases of SILENT. The prevailing outcome observed was persistent cerebellar dysfunction (77% of cases), often in combination with other sequelae. Other common sequelae included cognitive problems, parkinsonism, choreoathetosis, tardive dyskinesia, and peripheral neuropathy. The most common (61.4%) acute neurological symptom in the development of SILENT is an altered level of consciousness ranging from confusion to comatose states. Cerebellar sequelae were mentioned in 77% of cases as most common persistent sequelae. Antipsychotic use was mentioned in 59% of cases and fever was reported in 37.6% of cases. Scientific knowledge about this phenomenon has not advanced much since its initial reports in the 1960s and 1970s. While the use of lithium has become much more stringent than it had been in years past, and the occurrence of SILENT is rather exceptional, raising awareness about SILENT nevertheless remains crucial to avoid deleterious neurological consequences. Comprehensive, high-quality research in a systematic and standardized manner is therefore urgently needed to better understand this phenomenon.
摘要：
不可逆锂有效神经毒性综合征（SILENT）是一种罕见但与锂中毒有关的神经系统并发症。尽管自1960年代以来就有报道，沉默仍然知之甚少，以前关于这个主题的评论通常是叙事。因此，我们进行了范围审查，以评估有关锂毒性的长期神经系统后遗症的研究文献的性质和范围，并确定SILENT的最新知识。全面系统的文献检索,使用MEDLINE，Embase,和WebofScience数据库(从成立到2023年7月)，是针对英语和荷兰语文章进行的，评估锂中毒的长期神经系统后遗症。关于临床表现的关键信息，危险因素，治疗方法，或提取预防性测量。我们回顾了91篇文章，从117例沉默中提取信息。观察到的主要结果是持续的小脑功能障碍（77％的病例），常与其他后遗症结合。其他常见的后遗症包括认知问题，帕金森病,卵巢狭窄症,迟发性运动障碍,和周围神经病变。SILENT发展中最常见(61.4%)的急性神经症状是意识水平的改变,范围从混乱到昏迷状态。77％的病例提到小脑后遗症是最常见的持续性后遗症。59％的病例提到抗精神病药的使用，37.6％的病例报告发热。自从1960年代和1970年代的首次报道以来，关于这种现象的科学知识并没有取得很大进展。虽然锂的使用已经变得比过去几年严格得多，沉默的发生是相当例外的，但是，提高对SILENT的认识对于避免有害的神经系统后果仍然至关重要。全面,因此，迫切需要以系统和标准化的方式进行高质量的研究，以更好地理解这一现象。
