Neurology of ciguatera

Pearn, J. (2001) Neurology of ciguatera. Journal of Neurology Neurosurgery And Psychiatry, 70 1: 4-8. doi:10.1136/jnnp.70.1.4

Author Pearn, J.
Title Neurology of ciguatera
Journal name Journal of Neurology Neurosurgery And Psychiatry   Check publisher's open access policy
ISSN 0022-3050
Publication date 2001-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1136/jnnp.70.1.4
Volume 70
Issue 1
Start page 4
End page 8
Total pages 5
Editor C. Kennard
Place of publication London, England
Publisher BMJ Publishing Group
Collection year 2001
Language eng
Subject C1
320799 Neurosciences not elsewhere classified
730210 Environmental health
Abstract Ciguatera is a widespread ichthyosarcotoxaemia with dramatic and clinically important neurological features. This severe form of fish poisoning may present with either acute or chronic intoxication syndromes and constitutes a global health problem. Ciguatera poisoning is little known in temperate countries as a potentially global problem associated with human ingestion of large carnivorous fish that harbour the bioaccumulated ciguatoxins of the photosynthetic dinoflagellate Gambierdiscus toxicus. This neurotoxin is stored in the viscera of fish that have eaten the dinoflagellate and concentrated it upwards throughout the food chain towards progressively larger species, including humans. Ciguatoxin accumulates in all fish tissues, especially the liver and viscera, of at risk species. Both Pacific (P-CTX-1) and Caribbean (C-CTX-1) ciguatoxins are heat stable polyether toxins and pose a health risk at concentrations above 0.1 ppb. The presenting signs of ciguatera are primarily neurotoxic in more than 80% of cases. Such include the pathognomonic features of postingestion paraesthesiae, dysaesthesiae, and heightened nociperception. Other sensory abnormalities include the subjective features of metallic taste, pruritis, arthralgia, myalgia, and dental pain. Cerebellar dysfunction, sometimes diphasic, and weakness due to both neuropathy and polymyositis may be encountered. Autonomic dysfunction leads to hypotension, bradycardia, and hypersalivation in severe cases. Ciguatoxins are potent, lipophilic sodium channel activator toxins which bind to the voltage sensitive (site 5) sodium channel on the cell membranes of all excitable tissues. Treatment depends on early diagnosis and the early administration of intravenous mannitol. The early identification of the neurological features in sentinel patients has the potential to reduce the number of secondary cases in cluster outbreaks.
Keyword Clinical Neurology
Fish Poisoning
Public Health
Chronic Fatigue Syndrome
Toxin Exposure
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 100 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 14 Aug 2007, 15:31:11 EST