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Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk, MD, Loma Linda University Medical Center, Loma Linda,

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Presentation on theme: "Christina H. Hernon, MD, University of Massachusetts Memorial Hospital, Worcester, MA Brian J. Wolk, MD, Loma Linda University Medical Center, Loma Linda,"— Presentation transcript:

1 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

2 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

3 Disclosures: Dr. Wolk is a Co-investigator for Analatro (Black Widow Fab2 Antivenom) -Instituto Bioclon/Rare Disease Therapeutics

4 You can type your own categories and points values in this game board. Type your questions and answers in the slides we’ve provided. When you’re in slide show view, click a points box to go to that question, then click to move to the answer slide. Click the left triangle to return to this game board slide. Help, I just had a seizure in my hand! 100 200 300 400 500 Horrible Herbs 100 200 300 400 500 Yo! GABA GABA 100 200 300 400 500 Look-a-likes 100 200 300 400 500 That wasn’t a seizure; that was a dance move 100 200 300 400 500

5 Category 1 questions follow

6 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the left triangle to return to the game board slide. The primary mechanism of the toxin found in this substance. 100 Category 1 http://www.flickr.com/photos/bonjourwill/4528624762/sizes/o/

7 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Adenosine receptor antagonism 100 Category 1

8 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the left triangle to return to the game board slide. Rick James may have used a certain substance derived from this plant: 200 Category 1

9 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Coca Plant 200 Category 1 Coca Picture Refernce: http://upload.wikimedia.org/wikipedia/commons/7/72/Colcoca04.jpg

10 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the left triangle to return to the game board slide. This plant native to Southeast Asia: Hint: commonly used to ‘stun’ fish 300 Category 1

11 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Plant: Anamirta cocculus or Fishberries 300 Category 1 Picture Reference: http://upload.wikimedia.org/wikipedia/commons/7/70/Anamirta_cocculus_02.JPG

12 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the left triangle to return to the game board slide. 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. 400 Category 1

13 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Camphor 400 Category 1 http://plants.ifas.ufl.edu/misc/reco_cards/cincam.pdf http://i00.i.aliimg.com/photo/v0/105180782/Camphor_Bulk.jpg

14 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the left triangle to return to the game board slide. Latin name for the genus, toxin and mechanism of toxicity: 500 Category 1

15 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Aconitum, Aconitine, & Sodium-Channel Blockade Also known as Wolfsbane or Monskhood 500 Category 1 Picture Reference: http://upload.wikimedia.org/wikipedia/commons/7/70/Aconitum_napellus_Ticino.jpghttp://upload.wikimedia.org/wikipedia/commons/7/70/Aconitum_napellus_Ticino.jpg

16 Category 2 questions follow

17 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Plant and mechanism of action of its toxin: 100 Category 2 http://farm9.staticflickr.com/8301/7808736868_5ce5abf011_b.jpg Creative Commons License

18 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Tobacco/Nicotinic 100 Category 2

19 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This bane of livestock is terribly toxic. 200

20 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Cowbane or Cicuta Virosa 200 Category 2

21 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This edible ‘pea’ contains the neurotoxin -N- oxalylamino-L-alanine (BOAA) which is a glutamate agonist 300 Category 2

22 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Lathyrus Sativa (Chickling Pea) 300 Category 2

23 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This fall flower may give you seizures, but that could be the least of your problems: 400 Category 2 http://s0.geograph.org.uk/photos/54/59/545962_fd7cb876.jpg “© Copyright Evelyn Simak and licensed for reuse under this Creative Commons Licence.”

24 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Colchicum autumnale/autumn crocus (Colchicine) 400 Category 2

25 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This relative of water hemlock from the island of Sardinia may give you a Sardonic Grin: 500 Category 2

26 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Oenanthe fistulosa (Water Dropwort) 500 Category 2 http://commons.wikimedia.org/wiki/File:Illustratio n_Oenanthe_aquatica0.jpg

27 Category 3 questions follow

28 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. How does cocaine cause seizures? 100 Category 3 http:// farm3.staticflickr.com/2190/2170100460_2094dd2d6d_o.jpg

29 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Adrenergic/Sympathomimetic stimulation 100 Category 3

30 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. The antidote for ingestion of this savory shroom: 200 Category 3

31 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Pyridoxine -Gyromitrin metabolized to Monomethylhydrazine 200 Category 3 Picture Reference: http://upload.wikimedia.org/wikipedia/commons/9/97/Fr%C3%BChjahrslorchel.JPGhttp://upload.wikimedia.org/wikipedia/commons/9/97/Fr%C3%BChjahrslorchel.JPG

32 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. 300 Category 3 Before Redbull and Vodka, you could get your uppers & downers from a drink made with this plant:

33 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Artemisia absinthium or Wormwood 300 Category 3 Picture Reference: http://upload.wikimedia.org/wikipedia/commons/f/f5/Artemisia_absinthium_0002.JPG

34 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. 400 Category 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/BAhbB1sHOgZmIjsyMDExLzAzLzIxLzE2LzUwL zMyLzMxMS9TYWx0U3ByaW5nX011c3NlbHNfV2hvbGVfOC5qcGdbCDoGcDoKdGh 1bWIiDTQ1MHg0NTA+/SaltSpring_Mussels_Whole_8.jpg

35 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Glutamate Analogue/NMDA Agonist 400 Category 3 Picture 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.

36 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. The toxin and mechanism, respectively, of Anamirta cocculus 500 Category 3

37 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Toxin: Picrotoxin Mechanism: GABA inhibitor (non-competitive) May also inhibit glycine receptors 500 Category 3

38 Category 4 questions follow

39 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Socrates did NOT eat this: 100 Category 4

40 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Cicuta Maculata (Water Hemlock) 100 Category 4 Picture Reference: http://www.illinoiswildflowers.info/wetland/photos/wt_hemlock1.jpghttp://www.illinoiswildflowers.info/wetland/photos/wt_hemlock1.jpg

41 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This “false” fungus may be “tasty” but ingestion is inadvisable 200 Category 4

42 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Gyromitra Esculenta or the False Morel 200 Category 4

43 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. 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: 300 Category 4 http://farm5.staticflickr.com/4015/4525160667_8fb31c049c_b.jpghttp://farm5.staticflickr.com/4015/4525160667_8fb31c049c_b.jpg Creative Commons License

44 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Dicentra cucullaria/Dutchman's breeches Toxin: Bicuculline 300 Category 4

45 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This bad actor causes seizures less frequently than its cousin, and may be identifiable by its coloration: 400 Category 4 http://farm1.staticflickr.com/208/508080682_a19188ceb5_o.jpghttp://farm1.staticflickr.com/208/508080682_a19188ceb5_o.jpg Creative Commons License

46 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Conium maculatum or Poison Hemlock 400 Category 4

47 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. This stellate assassin is sometimes mistaken for its benign Chinese cousin: 500 Category 4

48 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Illicium anisatum/Japanese star anise (Anisatin) -non-competitive GABA (channel) inhibition 500 Category 4 Picture 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)

49 Category 5 questions follow

50 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. The NMDA agonist in this fungus theoretically could causes seizures, but rarely does due to it’s concomitant CNS depressant 100 Category 5

51 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Amanita Muscaria or Fly agaric 100 Category 5

52 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. 200 Category 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.”

53 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Ibotenic Acid 200 Category 5

54 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Chew on this, and you might get a little rush: 300 Category 5

55 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Qat or Khat (Cathinones) 300 Category 5

56 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Found in some traditional remedies, this toxin may give you a convulsion to remember 400 Category 5

57 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Strychnos Nux Vomica or Strynchine 400 Category 5

58 Question Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Specific mechanism by which this cellular asphyxiant may cause seizures (other than general cellular asphyxia): 500 Category 5 http://upload.wikimedia.org/wikipedia/commons/9/9e/Autumn_Red_peaches.jpg

59 Answer Type your questions and answers in the placeholders. You can add the points value at the bottom for reference. When you’re in slide show view, click the triangle to return to the game board slide. Glutamic Acid Decarboxylase Inhibition 500 Category 5


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