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Acute tetrodotoxin-induced neurotoxicity after ingestion of puffer fish

Authors

  • Matthew C. Kiernan PhD, FRACP,

    Corresponding author
    1. Prince of Wales Medical Research Institute, University of New South Wales, Australia
    2. Department of Neurology, Prince of Wales Hospital, Australia
    • Prince of Wales Medical Research Institute, Barker Street, Randwick, Sydney, NSW 2031, Australia
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  • Geoffrey K. Isbister MBBS, FACEM,

    1. Emergency Department, Newcastle Mater Misericordiae Hospital and University of Newcastle, Australia
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  • Cindy S.-Y. Lin PhD,

    1. Prince of Wales Medical Research Institute, University of New South Wales, Australia
    2. Department of Neurology, Prince of Wales Hospital, Australia
    3. Institute of Clinical Neurosciences, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
    4. Sobell Department of Neurophysiology, Institute of Neurology, London, United Kingdom
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  • David Burke DSc, FRACP,

    1. Institute of Clinical Neurosciences, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
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  • Hugh Bostock PhD, FRS

    1. Sobell Department of Neurophysiology, Institute of Neurology, London, United Kingdom
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Abstract

This study documents the effects of puffer-fish poisoning on peripheral nerve. Excitability measurements investigated membrane properties of sensory and motor axons in four patients. The median nerve was stimulated at the wrist, with compound muscle potentials recorded from abductor pollicis brevis and compound sensory potentials from digit 2. Stimulus–responses, strength–duration time constant (τSD), threshold electrotonus, and current–threshold relations were recorded. The urine of each patient tested positive for tetrodotoxin. Compared with controls, axons were of higher threshold, compound muscle action potentials and compound sensory nerve action potentials were reduced in amplitude, latency was prolonged, and τSD was reduced. In recovery cycles, refractoriness, superexcitability, and late subexcitability were decreased. Threshold electrotonus of motor axons exhibited distinctive abnormalities with less threshold decline than normal on depolarization and greater threshold increase on hyperpolarization (p < 0.0005 for each patient). The changes in excitability were reproduced in a mathematical model by reducing sodium (Na+) permeabilities by a factor of two. This study confirms that the neurotoxic effects of puffer-fish poisoning can be explained by tetrodotoxin blockade of Na+ channels. It demonstrates the ability of noninvasive nerve excitability studies to detect Na+ channel blockade in vivo and also the utility of mathematical modeling to aid interpretation of altered excitability properties in disease. Ann Neurol 2005;57:339–348

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