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Subsumed under this title is a diverse group of disorders of the nervous system that result from drugs and other injurious or poisonous substances. The neurologist must be concerned with the myriad of chemical agents that have no therapeutic utility but may adversely affect the nervous system; they abound in the environment as household products, insecticides, industrial solvents and other poisons, as well as those substances that may have therapeutic value but are used for their psychotropic effects, or are conventional medications with known toxic effects including those that are accidentally ingested. Also included among neurotoxins are those generated by bacteria and other infectious agents, as well as several found in nature, such as marine toxins and agents made by living organisms.

It would hardly be possible within the confines of this chapter to discuss the innumerable drugs and toxins that affect the nervous system. The interested reader is referred to a number of comprehensive monographs and references listed at the end of this chapter. In addition, a current handbook of pharmacology and toxicology should be part of the library of every physician.

The scope of this chapter is also limited because the therapeutic and adverse effects of many drugs are considered elsewhere in this volume in relation to particular symptoms and diseases. Thus, the toxic effects of ethyl, methyl, amyl, and isopropyl alcohol, as well as ethylene and diethylene glycol, are discussed in Chap. 42. The adverse effects of antibiotics on cochlear and vestibular function and on neuromuscular transmission are discussed in Chaps. 15 and 53, respectively. Many of the undesirable side effects of the common drugs used in the treatment of extrapyramidal motor symptoms, pain, headache, seizure and sleep disorders, psychiatric illnesses and so forth are also considered in the chapters dealing with each of these disorders and in the chapters that cover psychiatric diseases. Cyanide and carbon monoxide poisoning are discussed in relation to anoxic encephalopathy (Chap. 40). A number of therapeutic agents that damage the peripheral nerves (e.g., cisplatin, disulfiram, vincristine, dapsone) are mentioned in this chapter but are discussed further in Chap. 46, and those that affect muscle are discussed further in Chap. 51.

The presentation of this subject should be introduced by some general remarks on the action of drugs on the nervous system. The references at the end of the chapter are listed in relation to each of these categories:

  1. The general principles guiding the action of drugs on the nervous system

  2. Opiates and synthetic analgesics

  3. Sedative-hypnotic drugs

  4. Antipsychosis drugs

  5. Antidepressant drugs

  6. Stimulants

  7. Psychoactive drugs

  8. Bacterial toxins

  9. Plant poisons, venoms, bites, and stings

  10. Heavy metals

  11. Industrial toxins

  12. Antineoplastic and immunosuppressive agents

  13. Antibiotics

  14. Cardioactive agents

The rational use of any drug requires knowledge of the best route of administration, the drug’s absorption characteristics, its distribution in the nervous system and other organs and its biotransformations and excretion (pharmacokinetics...

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