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PubMed1997

Does bromide cause conversion of epilepsy to psychosis?

The aim of this study is to find out whether bromide was able to cause conversion of epilepsy to psychosis i.e., so-called paradoxical normalization such as has been seen in treatment with modern antiepileptic drugs. Spontaneous conversion has been known for three hundred years. Locock introduced bromide in the treatment of epilepsy in 1857. Belgrave wrote in 1868 on its effect on epileptic attacks and concommitant insanity. In 1868 Holm observed reduction of the frequency of seizures at the same time as psychotic symptoms or just dysphoria. In 1875 Voisin described a dose-dependent intoxication with psychosis and/or neurological signs. Stark in 1875 and Bannister in 1881 were the first to clearly describe the antagonism between epileptic seizures and psychotic symptoms, an antagonism or conversion described by many authors, both in cases with high and low dosage, and with and without intoxication. Thus, the title of this paper should be answered in the affirmative. Bromide has been used as a sedative and has rarely caused intoxication. Thus the presence of epilepsy is not a condition for the development of bromide intoxication. A case with epilepsy and fatal massive bromide intoxication is reported. It is discussed whether the pathological findings give support to Wolf's hypothesis of latent epileptic activity in subcortical pathways during "normalization".

Bromides↗
PubMed1976

Elevation of plasma bromide levels in patients following halothane anesthesia: Time correlation with total halothane dosage.

Plasma bromide concentrations of 25 patients were determined before and after halothane anesthesia. A high correlation (r greater than .70) between exposure to halothane in MAC-hours and plasma bromide levels 24, 48 and 72 hours later was found. Peak bromide levels occurred 48-72 hours after anesthesia in 16 patients (64 per cent), and ranged from 52 mug/ml (0.65 mEq/l) to 180 mug/mo (2.25 mEq/l). Bromide levels remained elevated for prolonged periods (at least 22 days in some patients). Possible sedative or psychoactive effects of increased plasma bromide levels are discussed.

Bromides↗
PubMed1990

The use of serum electrolyte concentrations determined by automated analyzers to indirectly quantitate serum bromide concentration.

Bromide is not often prescribed today as antiepileptic therapy. One reason is that serum bromide concentrations are not routinely performed in hospital laboratories, making clinical decisions difficult. Because of bromide ion interference with the electrodes of commonly used automated electrolyte analyzers, factitious "hyperchloremia" (and in some cases, "hyperbicarbonatemia"), are produced. These values, and the resulting calculated anion gap, correlate well with the measured serum bromide concentration. The correlation permits results from routine automated electrolyte analyzers to be used to indirectly determine serum bromide concentration.

Acid-Base Equilibrium↗
PubMed1979

Serum bromide after general anaesthesia with halothane.

Serum bromide was determined in 30 patients during the first few postoperative days after general anaesthesia with halothane. The material comprised a group of younger patients (19-50 years) and a group of elderly patients (greater than 70 years), neither of whom received thiomebumal induction, and a group of younger patients (19-50 years) who received thiomebumal induction. The changes in serum bromide were independent of age and induction with barbiturate, and a maximum rise in serum bromide was found most often 2-3 days after the anaesthesia. All groups showed a rise in serum bromide to therapeutically sedative concentrations, and a significant correlation was found between MAC-hours halothane exposure and serum bromide.

Adult↗
PubMed1982

ATP-independent proteolysis of globin cyanogen bromide peptides in rabbit reticulocyte cell-free extracts.

The catabolism of two rabbit globin cyanogen bromide peptides in cell-free extracts of ATP-depleted rabbit reticulocytes has been studied. Proteolysis of the peptides (3533 and 5957 molecular weight) proceeded rapidly in the absence of ATP, had a pH optimum of approximately 7.8, and was inhibited by omicron-phenanthroline, N-ethylmaleimide, cystamine zinc and cobalt ions, and puromycin peptide high-molecular-weight aggregates. Proteolysis of puromycin peptides was inhibited by the rabbit globin cyanogen bromide peptides. The ability of cell-free extracts of degrade the globin cyanogen bromide peptides decreased with the reticulocyte maturity. Blocking the globin cyanogen bromide peptide amino groups by succinic and maleic anhydride treatment decreased susceptibility to degradation. It is suggested that the globin cyanogen bromide peptides might provide model substrates, replacing puromycin peptides, for the investigation of ATP-independent proteolytic events.

Adenosine Triphosphate↗
PubMed2005

Pharmacokinetics of potassium bromide in adult horses.

OBJECTIVE: To determine the pharmacokinetics of potassium bromide (KBr) in horses after single and multiple oral doses. ANIMALS: Twelve adult Standardbred and Thoroughbred mares. PROCEDURE: Horses were randomly assigned to two treatment groups. Group 1 horses were given a single oral dose of 120 mg/kg potassium bromide. Part 2 of the study evaluated a loading dose of 120 mg/kg KBr daily by stomach tube for 5 days, followed by 40 mg/kg daily in feed for 7 days. Serum concentrations of KBr were measured to construct concentration versus time curves and to calculate pharmacokinetic parameters. Treated horses were monitored twice daily by clinical examination. Serum concentrations of sodium, potassium and chloride ions and partial pressures of venous blood gases were determined. RESULTS: Maximum mean serum concentration following a single dose of KBr (120 mg/kg) was 423 +/- 22 microg/mL and the mean elimination half-life was 75 +/- 14 h. Repeated administration of a loading dose of KBr (120 mg/kg once daily for 5 d) gave a maximum serum concentration 1639 +/- 156 microg/mL. The administration of lower, maintenance doses (40 mg/kg once daily) was associated with decreased serum bromide concentrations, which plateaued at approximately 1000 microg/mL. Administration of KBr was associated with significant but transient changes in serum potassium and sodium concentrations, and possible changes in base excess and plasma bicarbonate concentrations. High serum concentrations of bromide were associated with an apparent increase in serum chloride concentrations, when measured on an ion specific electrode. CONCLUSIONS: and clinical relevance Loading doses of 120 mg/kg daily over 5 d and maintenance doses of approximately 90 mg/kg of KBr administered once daily resulted in serum bromide concentrations consistent with therapeutic efficacy for the management of seizures in other species. The clinical efficacy of this agent as an anticonvulsant medication and/or calmative in horses warrants further investigation.

Administration, Oral↗
PubMed1985

Renal failure and upper urinary tract obstruction after retrograde pyelography with potassium bromide solution.

Two iodine-sensitive women in whom potassium bromide solution was used as a radiocontrast agent for retrograde pyelography developed similar clinical conditions culminating in renal failure. Renal failure was due to upper urinary tract obstruction from fibrosis and fat necrosis in each case. Similar histological findings have been described in rabbit bladder exposed to sodium bromide solution. Different patterns of exposure corresponded with different sites of major damage in the two cases. One patient, who had repeated studies of the pelvicalyceal system with potassium bromide developed papillary necrosis. Systemic exposure to bromide-releasing compounds (in animals) and to bromides (in humans) has also been associated with papillary necrosis.

Adult↗
PubMed1993

The no-effect level of sodium bromide in healthy volunteers.

1. A total of 0, 4 and 9 mg kg-1 body weight sodium bromide was administered orally to 45 healthy female volunteers. 2. The experiment lasted for six menstrual cycles: only during the first three cycles was bromide administered; 3. At the start, at the end of the administration period and at the end of the experiment a physical examination and haematological and routine clinical chemistry tests were performed. Except for nausea in relation to the intake of bromide, no adverse effects were observed. 4. The bromide concentration in plasma rose to 3.22 +/- 0.93 mmol kg-1 in the 4 mg kg-1 group and to 7.99 +/- 1.89 in the 9 mg kg-1 group by the end of the administration period. 5. Before and at the end of the experiment the thyroid hormones (T4, FT4, TBG, T3 and TSH) were analysed. No significant differences were observed between the groups. 6. Before, after three menstrual cycles and at the end of the experiment an EEG with a Visual Evoked Response was recorded. At the 4 and 9 mg kg-1 dose level in the alpha 1-band and the beta-bands significant changes were found (P < 0.1 and P < 0.05, respectively). The Visual Evoked Response showed no significant differences between the three groups. 7. From this experiment and previous experiments a no-effect level in humans for sodium bromide of 4 mg kg-1 body weight is proposed.

Adult↗
PubMed2002

Tiotropium bromide: a novel once-daily anticholinergic bronchodilator for the treatment of COPD.

Tiotropium bromide (Spiriva, BA679BR, Boehringer Ingelheim) is a novel inhaled, long-acting anticholinergic bronchodilator that is employed as a once-daily maintenance treatment for patients with chronic obstructive pulmonary disease (COPD). Like ipratropium bromide, tiotropium bromide is a quaternary ammonium derivative that binds to muscarinic receptors. However, although tiotropium binds with high affinity to muscarinic receptors of M1-, M2- and M3-subtypes, it dissociates very slowly from M1- and M3-receptors but more rapidly from M2-receptors, thereby giving it a unique kinetic selectivity. To date, the short-acting anticholinergic agents ipratropium and oxitropium bromide have been extensively employed as bronchodilator therapy for patients with COPD. Indeed, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy emphasises the role of bronchodilators in symptomatic management of all stages of COPD. It is encouraging that tiotropium given once daily from a dry powder inhaler at 18 g has been shown to cause greater improvement in lung function and reduction in symptoms than ipratropium bromide given four times daily. Furthermore, clinical studies over a 1-year period have demonstrated that tiotropium has impressive and maintained effects on lung function, symptoms and health-related quality of life, and may also reduce exacerbations. In a recent large scale comparative study over 6 months, tiotropium has been shown to cause superior bronchodilation and symptomatic improvement when compared to twice daily salmeterol in COPD. The only significant reported adverse event is dry mouth, which is found in approximately 10%-15% of subjects, but this is reversible and rarely causes discontinuation of therapy. Based on these promising features, it is likely that tiotropium used alone or in combination with other bronchodilators will emerge as first-line maintenance treatment for patients with airway obstruction due to COPD.

Administration, Inhalation↗
PubMed2001

Tiotropium bromide.

Tiotropium bromide is a new long-lasting anticholinergic drug which, like ipratropium bromide, is a quaternary ammonium derivative. It binds with high affinity to muscarinic receptors but dissociates very slowly from M(1)- and M(3)-muscarinic receptors. Pharmacology studies have demonstrated a prolonged protective effect against cholinergic agonists and cholinergic nerve stimulation in animal and human airways. In Phase II studies single inhaled doses of tiotropium bromide have a bronchodilator and bronchoprotective effect in asthmatic and chronic obstructive pulmonary disease (COPD) patients of over 24 h. In Phase III studies, once daily inhaled tiotropium is an effective bronchodilator in COPD patients, giving great improvement in lung function and reduction in symptoms than ipratropium bromide given four times daily. The drug is well-tolerated and the only side effect of note is dryness of the mouth which occurs in approximately 10% of patients. Since, anticholinergics are the bronchodilators of choice in COPD it is likely that tiotropium bromide will become the most widely used bronchodilator for COPD patients in the future.

Animals↗
PubMed2001

Detection of shared magnetic antigenic determinants on whole Moraxella bovis pili by use of antisera to cyanogen bromide-cleaved M. bovis pilus protein.

OBJECTIVE: To determine the ability of antisera against cyanogen bromide-cleaved pili from 4 strains of Moraxella bovis to react with whole or nondenatured pili. SAMPLE POPULATION: Antisera to 4 strains of M. bovis produced by New Zealand White rabbits. PROCEDURE: Pili from 4 strains of M. bovis were collected and purified. Pilus proteins (pilin) were cleaved, using cyanogen bromide. Whole pilus and cyanogen bromide-cleaved pilin were injected into rabbits. Antisera were serially diluted, reacted with 4 strains of M. bovis, and examined by immunoelectron microscopy and indirect immunofluorescence. RESULTS: Antisera to whole pili aggregated and distorted pili from homologous strains, but pili from heterologous strains were unaffected. Antisera to cleaved pilin fragments resulted in partial aggregation and thickening of homologous and heterologous pili, suggestive of heterospecific antibodies. Attachment of antibodies to pili was detected by indirect immunofluorescence, indicating a strong reaction of antisera to whole pili with homologous pili. Weak cross-reactions were evident with certain heterologous strains. In contrast, antisera to cleaved pilin fragments reacted strongly with pili from homologous and heterologous strains. CONCLUSIONS AND CLINICAL RELEVANCE: We detected shared antigenic determinants on pili from various strains of M. bovis that were not immunogenic in intact pili. These sites were immunogenic after cleavage of pilus protein with cyanogen bromide, and antisera produced to protein fragments reacted with whole pili from heterologous strains of the organism. Vaccines produced from cyanogen bromide-treated pili may induce broader immunity against infectious bovine keratoconjuctivitis than that provided by currently available vaccines.

Animals↗
PubMed1999

Does maternal drug ingestion cause megacystis microcolon intestinal hypoperistalsis syndrome? II. Bromide trial.

PURPOSE: Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a congenital disease, and the etiology of the disease is unclear. It is speculated that maternal ingestion of some drugs during pregnancy and degeneration of smooth muscle cells in the fetus may be an etiologic factor. In this study we aimed to investigate the effect of maternal ingestion of bromide on the fetal bladder and colon in pregnant rats. METHOD: We separated animals into a bromide group including 30 rats and a control group with 14 rats. Nothing was given to the control group during pregnancy. Intraperitoneally 8 mg/kg/day bromide was given to the study group from the 6th to 12th day of pregnancy. All of the rats were sacrificed on the 20th day of pregnancy. Histopathological examination of fetal colons and bladders was performed. RESULTS: In the bromide group, an increase in the colon and bladder diameter, an increase in muscle atrophy in the colon and bladder wall, an increase in vacuolar degeneration in the muscles of the bladder and colon wall, and a significant decrease in ganglion cell numbers in the myenteric plexus of the colon and bladder were determined. CONCLUSION: In our rat model, we found histological structural changes in the rats' colon and bladder walls as a result of using bromide on the 6-12th days of pregnancy similar to pathological findings found in some of MMIHS patients' bowels and bladders.

Abnormalities, Drug-Induced↗
PubMed1979

[Bromide encephalopathies (author's transl)].

Bromide encephalopathies are frequently reported in Northern America and Great Britain. There is no characteristic clinical pattern, the neurological symptoms are multiple, this is readily explained by the diffusion of bromide ions to all regions in the central nervous system. An accurate history (bromide intake, followed by the slow onset of digestive and neuropsychiatric symptoms) as well as an apparent hyperchloremia are of the greatest aid in suggesting the diagnosis. The incidence of this type of intoxication is greater in women over 50. The association of a salt free diet to bromide therapy favors the onset of clinical symptoms because of the competition between bromide and chloride at the choroid plexus and at the renal tubule.

Brain Diseases↗
PubMed1984

Bromide psychosis: a literary case.

Author Evelyn Waugh, noted for such works as Brideshead Revisited, published in 1957 an autobiographical account of his own bromide psychosis in the novel The Ordeal Of Gilbert Pinfold. Until now, however, the fact of his bromide poisoning had gone unrecognized both in biographies of Waugh and in analyses of the novel. Ordeal gives a detailed, accurate, day-by-day description of bromide psychosis. This unusual, witty, and fascinating piece of literature actually provides the most complete monograph on the subject. In this article we review the literature on bromide poisoning, discuss the events of the novel and of Waugh's life in light of his bromide psychosis, and suggest the relevance of the case to medicine.

Bromides↗
PubMed1984

Prolonged bromide intoxication resulting from a gastric bezoar.

Bromide intoxication is now a relatively uncommon disease. We describe a critically ill patient who had an elevated chloride level and neurologic abnormalities. Bromide levels were also elevated, and remained so for several days. After more than 12 days of abnormally high serum bromide and chloride levels, endoscopy was performed. This procedure disclosed a gastric bezoar containing identifiable pill fragments. The gastric washings from these fragments contained high levels of bromide. We believe that the prolonged course of bromide intoxication secondary to a gastric bezoar makes this case unique.

Adult↗
PubMed1978

Increased plasma bromide concentration in the horse after halothane anesthesia.

A long-lasting increase of the plasma bromide concentration was found in 25 horses after clinical halothane anesthesia. The plasma bromide concentration was significantly (P less than 0.005) increased at the end of anesthesia. In 18 horses, peak values were reached between 48 and 72 hours after anesthesia. Eighteen days after horses had been anesthetized, the plasma bromide concentration remained significantly (P less than 0.005) increased. Significant correlation was not found between the total dose of halothane and the plasma bromide concentration. In 1 horse reanesthetized with halothane 4 days after initial halothane anesthesia, the plasma bromide concentration increased to high concentrations.

Anesthesia, Inhalation↗
PubMed1980

Serum bromide concentrations during and after halothane anesthesia in dogs.

Serum bromide concentrations of ten dogs were determined before, during, and after 2 hours of anesthesia with halothane. Serum bromide concentrations increased significantly (P less than 0.05), beginning at 30 minutes of anesthesia and remained significantly (P less than 0.05) increased until the end of the experiment--10 days after anesthesia. Peak bromide concentration occurred 1 day after anesthesia in five dogs (50%) and varied between 4 mg/dl and 8.8 mg/dl. Bromide concentration remained significantly (P less than 0.05) increased for the length of the experiment. Possible sedative or psychoactive levels of increased serum bromide concentrations are discussed.

Anesthesia, Inhalation↗
PubMed1996

High dietary chloride content associated with loss of therapeutic serum bromide concentrations in an epileptic dog.

Bromide treatment was successful in controlling seizures in an 11-year-old Dachshund with epilepsy and presumptive phenobarbital-associated hepatopathy. Because bromide does not induce liver enzyme activity and does not seem to be hepatotoxic, it can be used to control seizures in dogs with concurrent epilepsy and hepatic disease. In this dog, institution of a special calculolytic diet with high chloride content was associated with a decrease in serum bromide concentrations and the recurrence of seizures. High chloride intake increases the elimination of bromide in dogs, leading to higher dosage requirements for bromide in dogs fed high-chloride diets.

Animals↗