Letter to the Editor
Opsoclonus-myoclonus syndrome secondary to duloxetine toxicity
Síndrome de opsoclono-mioclono secundario a intoxicación por duloxetina
Read
3290
Timeswas read the article
473
Total PDF
2817
Total HTML
Share statistics
array:24 [ "pii" => "S2173580821000055" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.05.017" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1433" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:250-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485320301328" "issn" => "02134853" "doi" => "10.1016/j.nrl.2020.05.009" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1433" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:250-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Síndrome de opsoclono-mioclono secundario a intoxicación por duloxetina" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "252" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Opsoclonus-myoclonus syndrome secondary to duloxetine poisoning" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Trigo López, E. Martínez Pías, A. Carrancho García, M.I. Pedraza Hueso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Trigo López" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Martínez Pías" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Carrancho García" ] 3 => array:2 [ "nombre" => "M.I." "apellidos" => "Pedraza Hueso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580821000055" "doi" => "10.1016/j.nrleng.2020.05.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000055?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485320301328?idApp=UINPBA00004N" "url" => "/02134853/0000003600000003/v1_202103200928/S0213485320301328/v1_202103200928/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173580821000043" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.03.003" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1435" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2021;36:248-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Anterior medullary infarction after bronchial embolisation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "248" "paginaFinal" => "250" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto medular anterior tras embolización bronquial" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 508 "Ancho" => 1255 "Tamanyo" => 97049 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Digital subtraction angiography shows the right intercostobronchial trunk (black arrow), feeding a hypertrophic bronchial artery (black arrowhead), and pathological intrapulmonary vascularisation. The intercostobronchial trunk also gives rise to a common trunk for several intercostal arteries (white arrow), which feed several radiculomedullary arteries; the anterior medullary artery is not visible at this level (white arrowhead). B) Right intercostal artery at the T8 level, which gives rise to the radiculomedullary artery that connects with the anterior medullary artery (arrow). No embolisation procedure was performed at this level.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ramírez Torres, C. Lastras Fernández, J. Rodríguez Pardo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez Torres" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Lastras Fernández" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Rodríguez Pardo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485320301341" "doi" => "10.1016/j.nrl.2020.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485320301341?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000043?idApp=UINPBA00004N" "url" => "/21735808/0000003600000003/v1_202103190809/S2173580821000043/v1_202103190809/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Opsoclonus-myoclonus syndrome secondary to duloxetine toxicity" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "252" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Trigo López, E. Martínez Pías, A. Carrancho García, M.I. Pedraza Hueso" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Trigo López" "email" => array:1 [ 0 => "javiertrigolopez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Martínez Pías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Carrancho García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.I." "apellidos" => "Pedraza Hueso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de opsoclono-mioclono secundario a intoxicación por duloxetina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Opsoclonus-myoclonus syndrome (OMS) is extremely rare, with incidence estimated at 0.18 cases/1 000 000 person-years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinically, it is characterised by the presence of 3 symptoms: opsoclonus, myoclonus, and ataxia. Opsoclonus is defined as involuntary, rapid, multidirectional conjugate saccadic eye movements. Myoclonus most frequently affects the trunk or limbs, and is usually postural or induced by movement. Ataxia may be caused by severe myoclonus or by cerebellar damage. Other associated symptoms include cognitive dysfunction, behavioural alterations, encephalopathy, cranial nerve alterations (cranial nerves IV, V, and VI), and seizures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">OMS in children is well characterised; the most frequent aetiology is paraneoplastic, in the context of neuroblastoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to the literature, the most frequent aetiologies in adults are paraneoplastic, infectious, or idiopathic, with metabolic or toxic causes being exceptional.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present a case of OMS secondary to duloxetine toxicity.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 44-year-old woman with history of anxiety and depression, for which she was being treated with lorazepam. She was referred by the emergency department after presenting blurred vision, involuntary movements, and visions of “hooded people” in her home, who the patient believed had poisoned her; symptoms began upon awakening. Upon arrival, she was haemodynamically stable, but presented tachycardia. In the assessment of higher cognitive functions, she was alert, oriented to time and person but disoriented to place, and inattentive; she spoke little but showed no signs of dysphasia, with preserved comprehension. One reiterative utterance was noted (“I’ve been poisoned”). In the cranial nerve examination, we observed mydriasis with impaired pupillary light reflex, and rapid, multidirectional, conjugate eye movements compatible with opsoclonus. Finally, she presented action myoclonus in all 4 limbs and the trunk (see Supplementary Material for video). Emergency complementary tests included a complete blood count and biochemistry profile, venous blood gas analysis, urine analysis, urine toxicology, and brain MRI. All results were normal or negative, with the exception of neutrophilic leukocytosis and positive results for benzodiazepines in the urine. We also performed an emergency lumbar puncture; cerebrospinal fluid biochemistry showed no significant alterations, and samples were taken for a microbiology study, oligoclonal banding, an anatomical pathology study, and antineuronal and onconeuronal antibody testing. The patient was admitted with a diagnosis of OMS associated with delusional ideation and visual hallucinations. We started empirical treatment with high-dose corticosteroids (intravenous methylprednisolone dosed at 1 g for 5 days). We also screened for a primary tumour: results for tumour markers were negative, and a mammogram and a chest-abdomen-pelvis CT scan revealed no signs of malignancy. The serology study, anatomical pathology study, and antineuronal and onconeuronal antibody tests of cerebrospinal fluid samples all returned negative results.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Five days after admission, symptoms progressively improved and eventually resolved; the patient acknowledged having consumed 3 packages of duloxetine 30 mg the night prior to symptom onset, with suicidal intent. We tested for duloxetine in the plasma, finding a concentration of 371 ng/mL (therapeutic range, 20-80).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Toxic aetiology of OMS is extremely rare. The literature includes cases of OMS induced by amitriptyline, cocaine, lithium, phenytoin, phenelzine, ciclosporin, ipilimumab/nivolumab, cefepime, and venlafaxine.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–13</span></a> To our knowledge, this is the first case of OMS associated with duloxetine toxicity, and the second case associated with a serotonin-norepinephrine reuptake inhibitor (the first case was reported in a patient receiving venlafaxine). The pathophysiological mechanisms explaining OMS of toxic aetiology are unclear. In general, the syndrome is thought to originate from dysfunction of the omnipause neurons of the nucleus raphe interpositus<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or disinhibition of the fastigial nucleus in the cerebellum<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>; however, these structures are neither serotonergic nor norepinephrinergic. Necpál and Skorvanek<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> suggest that the case they report of OMS associated with venlafaxine toxicity may have been explained by serotonin syndrome, as the patient presented mental, neuromuscular, and autonomic alterations. Our patient also presented alterations in all 3 of these domains: mental (psychosis), neuromuscular (opsoclonus/myoclonus), and autonomic (tachycardia, mydriasis); this supports the hypothesis proposed by Necpál and Skorvanek.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Additionally, while increased production of catecholamines is observed in patients with neuroblastoma,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> there is very little evidence that a norepinephrinergic effect is involved in the pathogenesis of OMS. Therefore, while we cannot completely rule it out, norepinephrinergic origin seems less likely in these cases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, while it is very infrequent, toxic aetiology is highly relevant in the aetiological diagnosis of OMS. This is the second case of OMS associated with serotonin-norepinephrine reuptake inhibitors; serotonin syndrome may have played a role in pathogenesis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Trigo López J, Martínez Pías E, Carrancho García A, Pedraza Hueso MI. Síndrome de opsoclono-mioclono secundario a intoxicación por duloxetina. Neurología. 2021;36:250–252.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.zip" "ficheroTamanyo" => 9699814 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study of the presentation and management of dancing eye syndrome/opsoclonus-myoclonus syndrome in the United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.K. Pang" 1 => "C. de Sousa" 2 => "B. Lang" 3 => "M.G. Pike" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejpn.2009.03.002" "Revista" => array:6 [ "tituloSerie" => "Eur J Paediatr Neurol." "fecha" => "2010" "volumen" => "14" "paginaInicial" => "156" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19423368" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An uptdate on opsoclonus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Wong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WCO.0b013e3280126b51" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Neurol." "fecha" => "2007" "volumen" => "20" "paginaInicial" => "25" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17215685" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on diagnosis, treatment, and prognosis in opsoclonus-myoclonus-ataxia syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.P. Gorman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOP.0b013e32833fde3f" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pediatr." "fecha" => "2010" "volumen" => "22" "paginaInicial" => "745" "paginaFinal" => "750" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20871403" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult-onset opsoclonus-myoclonus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Klaas" 1 => "J.E. Ahlskog" 2 => "S.J. Pittock" 3 => "J.Y. Matsumoto" 4 => "A.J. Aksamit" 5 => "J.D. Bartleson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archneurol.2012.1173" "Revista" => array:6 [ "tituloSerie" => "Arch Neurol." "fecha" => "2012" "volumen" => "69" "paginaInicial" => "1598" "paginaFinal" => "1607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22986354" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus with amitriptyline overdose" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.J. Au" 1 => "J.L. Keltner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.410060128" "Revista" => array:5 [ "tituloSerie" => "Ann Neurol." "fecha" => "1979" "volumen" => "6" "paginaInicial" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/507769" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus, a rare complicación of cocaine misuse" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Elkadoudi-Pijnenburg" 1 => "A.G. Van Vliet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "1996" "paginaInicial" => "60" "paginaFinal" => "592" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lithium carbonate, haloperidol, and irreversible brain damage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.J. Cohen" 1 => "N.H. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "JAMA." "fecha" => "1974" "volumen" => "230" "paginaInicial" => "1283" "paginaFinal" => "2128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4479505" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109711028762" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus induced by phenytoin and diazepam" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Dehaene" 1 => "B. Van Vleymen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.410210220" "Revista" => array:5 [ "tituloSerie" => "Ann Neurol" "fecha" => "1987" "volumen" => "21" "paginaInicial" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3827233" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular flutter" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.M. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Neuroophtalmol" "fecha" => "1990" "volumen" => "10" "paginaInicial" => "155" "paginaFinal" => "156" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus-myoclonus syndrome following long-term use of cyclosporine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.G. Kang" 1 => "S.K. Park" 2 => "S.J. Wang" 3 => "S.Y. Oh" 4 => "H.U. Ryu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/15563650.2017.1375511" "Revista" => array:6 [ "tituloSerie" => "Clin Toxicol (Phila)." "fecha" => "2018" "volumen" => "56" "paginaInicial" => "373" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28905654" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ipilimumab/Nivolumab-related Opsoclonus-Myoclonus-Ataxia Syndrome Variant in a Patient with Malignant Pleural Mesothelioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Maller" 1 => "E. Peguero" 2 => "T. Tanvetyanon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CJI.0000000000000228" "Revista" => array:6 [ "tituloSerie" => "J Immunother." "fecha" => "2018" "volumen" => "41" "paginaInicial" => "411" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29742520" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus-myoclonus-encephalopathy induced by cefepime" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.J. Lizarraga" 1 => "D.O. Heros" 2 => "D. Adams" 3 => "A.E. Lang" 4 => "A.M. Kanner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jns.2018.10.028" "Revista" => array:7 [ "tituloSerie" => "J neurol Sci." "fecha" => "2019" "volumen" => "396" "paginaInicial" => "33" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30412900" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S014067361561220X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opsoclonus-myoclonus ataxia syndrome secondary to venlafaxine intoxication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Necpál" 1 => "M. Skorvanek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jns.2016.11.023" "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci." "fecha" => "2017" "volumen" => "372" "paginaInicial" => "19" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28017210" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "fMRI study. Cerebellar activation in opsoclonus: an fMRI study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Helmchen" 1 => "H. Rambold" 2 => "A. Sprenger" 3 => "C. Erdmann" 4 => "F. Binkofski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/01.wnl.0000073271.66866.51" "Revista" => array:6 [ "tituloSerie" => "Neurology." "fecha" => "2003" "volumen" => "61" "paginaInicial" => "412" "paginaFinal" => "415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12913213" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The neurobiology of the opsoclonus-myoclonus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.R. Pranzatelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00002826-199206000-00002" "Revista" => array:6 [ "tituloSerie" => "Clin. Neuropharmacol." "fecha" => "1992" "volumen" => "15" "paginaInicial" => "186" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1394242" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003600000003/v1_202103190809/S2173580821000055/v1_202103190809/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003600000003/v1_202103190809/S2173580821000055/v1_202103190809/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000055?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 2 | 14 |
| 2024 October | 93 | 10 | 103 |
| 2024 September | 83 | 12 | 95 |
| 2024 August | 71 | 9 | 80 |
| 2024 July | 66 | 10 | 76 |
| 2024 June | 83 | 10 | 93 |
| 2024 May | 75 | 9 | 84 |
| 2024 April | 52 | 5 | 57 |
| 2024 March | 75 | 10 | 85 |
| 2024 February | 84 | 4 | 88 |
| 2024 January | 78 | 5 | 83 |
| 2023 December | 89 | 9 | 98 |
| 2023 November | 85 | 11 | 96 |
| 2023 October | 97 | 24 | 121 |
| 2023 September | 90 | 9 | 99 |
| 2023 August | 88 | 6 | 94 |
| 2023 July | 72 | 11 | 83 |
| 2023 June | 94 | 9 | 103 |
| 2023 May | 110 | 8 | 118 |
| 2023 April | 86 | 2 | 88 |
| 2023 March | 56 | 18 | 74 |
| 2023 February | 58 | 3 | 61 |
| 2023 January | 43 | 6 | 49 |
| 2022 December | 33 | 7 | 40 |
| 2022 November | 42 | 7 | 49 |
| 2022 October | 39 | 12 | 51 |
| 2022 September | 39 | 8 | 47 |
| 2022 August | 44 | 13 | 57 |
| 2022 July | 34 | 8 | 42 |
| 2022 June | 35 | 10 | 45 |
| 2022 May | 65 | 9 | 74 |
| 2022 April | 40 | 22 | 62 |
| 2022 March | 51 | 14 | 65 |
| 2022 February | 51 | 2 | 53 |
| 2022 January | 60 | 6 | 66 |
| 2021 December | 41 | 11 | 52 |
| 2021 November | 55 | 9 | 64 |
| 2021 October | 55 | 19 | 74 |
| 2021 September | 41 | 11 | 52 |
| 2021 August | 37 | 9 | 46 |
| 2021 July | 37 | 7 | 44 |
| 2021 June | 44 | 13 | 57 |
| 2021 May | 81 | 19 | 100 |
| 2021 April | 133 | 42 | 175 |
| 2021 March | 16 | 7 | 23 |
| 2021 February | 4 | 6 | 10 |
Show all
