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literature.[1] Another noteworthy fact is that both 2. Jimenez-Jimenez FJ, Puertas I, de Toledo- of our patients were young females, which Heras M. Drug-induced myoclonus: Frequency, is in contrast to previous literature.[2,3] Even the previous case report of myoclonus with quetiapine has been reported in an elderly induced myoclonus. Int Clin Psychopharmacol male.[3] However, the patient was also receiving citalopram. We could Þ nd only one other case 4. Strachan PM, Benoff BA. Mental status change, report where myoclonus has been reported with myoclonus, electrocardiographic changes, and acute respiratory distress syndrome induced by quetiapine overdose. Pharmacotherapy It could be argued that the previous history of seizures in our first case and history of 5. Goldstein JM. Quetiapine fumarate (Seroquel): myoclonus on another antipsychotic may have A new atypical antipsychotic. Drugs Today predisposed the patient to the quetiapine- induced EEG changes, and that the myoclonic jerks were part of a seizure disorder. Regarding the pathophysiology of these jerks, the action CERVICAL STIMULATION FOR
of quetiapine on multiple neurotransmitters VOLUMETRIC REDUCTION OF
may be involved, especially on serotonin and LIMBS IN THE TREATMENT OF
Our cases highlight the need for careful monitoring of patients on quetiapine, especially Godoy and Godoy describe in this study a new those with prior history of seizures or of any lymph drainage technique which is different from those previously described. It can be performed in isolation, as in cases of the face, ASHISH AGGARWAL, R. C. JILOHA
or in conjunction with body lymph drainage. Department of Psychiatry, G.B. Pant Hospital, The technique is extremely simple and, with due care, we believe the method is easily Correspondence:
Fifteen female and three male patients with REFERENCES
age of 57.8 years with grade II lymphedema of lower limbs in its initial phase (within three 1. Amann BL, Pogarell O, Mergl R, Juckel G, Grunze to four months of onset as reported by the H, Mulert C, et al. EEG abnormalities associated patient) were selected over a two-year period. with antipsychotics: A comparison of quetiapine, Grade I lymphedema is deÞ ned as lymphedema olanzapine, haloperidol and healthy subjects. that evolves during the day with patients having no signs of the disease after a night’s Indian J Med Sci, Vol. 62, No. 10, October 2008 [Downloaded free from on Monday, December 22, 2008]
rest. With Grade II lymphedema, the patient the volume of limbs affected by lymphedema. awakens with swelling of the limbs.[3] Diagnosis In our opinion this is the first time that this of lymphedema was clinical, confirmed by has been reported, as there are no published studies evaluating this approach. Thus, this is a new concept based on physical stimulation that All patients were submitted to twenty-minute utilizes light (almost tickling) digital movements. daily sessions of cervical stimulation for five consecutive days. Stimulation of the This finding raises a series of hypotheses cervical region uses very light movements to explain the effect of stimulation with the (almost tickling) of the fingers or thumbs authors suggesting a possible interference without exerting pressure, as shown in Þ gure in the contractions of lymphangions of the 1.(2) Approximately 40 to 60 stimuli were lymphatic system via neurological stimuli and employed per minute. The limb was evaluated thus adding a probable synergic effect to by volumetry, using the water displacement technique, before and after the treatment located in the space between two valves of the program. For statistical analysis, the paired vessels and constitute a contractile unit similar student t-test was utilized with an alpha error to the heart with their own beats and stimuli. of 5% considered acceptable (P-value < 0.05). The research was approved by the Research The Þ ndings of this study reinforce this hypothesis; Ethics Committee of the Medical School in São stimulation of determined regions of the body, Jose do Rio Preto, Brazil and patient consent in this case the cervical region, can trigger responses at a distance, here presumably stimulating contractions of the lymphangions of Statistically signiÞ cant volumetric reductions were detected for all limbs (P-value = 0.0003), with an average reduction of 138.6 grams.
To conclude, the aim of this study was only to prove that stimulation reduces the size of edematous legs and this objective was technique of cervical region stimulation reduces achieved. Hence we need to attempt to identify the mechanism that causes this effect. JOSÉ MARIA PEREIRA DE GODOY, SILVIA
Livre Docente of the Cardiology and Cardiovascular Surgery Department of the Medical School in São José do Rio Preto (FAMERP), Professor of the Graduation and post graduation courses of FAMERP and CNPq 1Physiotherapist, Student of Post Graduation the Medical School, São José do Rio Preto-SP-FAMERP, 2Physiotherapist, student of the Latu Sensu Lymphedema Figure 1: Cervical region stimulation
rehabilitation post graduation course - FAMERP, Indian J Med Sci, Vol. 62, No. 10, October 2008 [Downloaded free from on Monday, December 22, 2008]
3Occupational therapist, professor of the Lato sensu of cervical stimulation in the reduction of edema Lymphedema rehabilitation post graduation course of of the face after cancer treatment. Q J Med Medical School, São José do Rio Preto-SP-FAMERP Correspondence:
2. Godoy and Godoy technique of cervical stimulation Rua Floriano Peixoto, 2950, São Jose do Rio Preto-SP-Brazil Zipe code: 15020-010, Tel/fax: 55 17 32326362 for lymphatic drainage. Available from: http://www. 11th September 2008.
3. Board J, Harlow W. Lymphoedema 2: ClassiÞ cation, signs, symptoms and diagnosis. Br J Nurs 1. Godoy JM, Godoy MF. Godoy and Godoy technique Indian J Med Sci, Vol. 62, No. 10, October 2008



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