EEG changes associated with lithium use in patients

Lithium influences on EEG
Brief lit review

1. Lithium and EEG
David Hartmann MD PhD

2. On admission, lithium level was in the toxic range 3.34 mmol/L (therapeutic range 0.6–1.2, toxic range >1.5),
2.97 mmol/L and 1.45 mmol/L on the second and third day, respectively.
EEG w diffuse asynchronous high-amp theta.

3. She was dialyzed
EEG normal

4. What does normal lithium do? Slowing.
In 12 patients with affective disorders (ICD-10: F31, F32, F33), EEGs were recorded before and after 4.4 months of lithium
treatment. Effects of lithium on the EEG were analyzed by power spectral analysis controlled for vigilance. We found (1) an
increase in relative power in both delta and theta band which was related to the lithium plasma level, (2) a decrease in
relative alpha power especially at occipital leads and (3) a reduction of the dominant alpha frequency.
Neuropsychobiology (2000) 42 (Suppl. 1): 33–37.
It has been consistently shown that lithium enhances resting-state delta and theta oscillations in spontaneous EEG studies of
patients with bipolar disorder
34–36
or in healthy volunteers.
37,38

Neuropsychiatr Dis Treat. 2016 Mar 7:12:589-601.

5. What does excess lithium do? NCSE
About 10 published cases lithium toxicity
causing NCSE
Epilepsia. 2006 Dec;47(12):2071-4.


EEG sample from patient 2. The patient was lethargic
with tremor, myoclonias, dysarthria, hyperreflexia, and a
lithium level of 4.5 μg/ml at the time of admission.
Lithium was <1.5 μg/ml at the time of the EEG. A
bipolar, anteroposterior montage reveals bifrontal
epileptiform morphologies at 2–4 Hz. After lorazepam,
these resolve to a pattern of diffuse 1-Hz delta activity
with diffuse biphasic and triphasic morphologies, but
without clinical improvement.
→ EEG improvement seems delayed relative to normal
lithium level

6. References


https://casereports-bmj-com.laneproxy.stanford.edu/content/14/11/e246499.long#r
ef-11 – high amp theta that dialyzed away w toxic lithium in the 3-4 range.
https://pubmed.ncbi.nlm.nih.gov/11093069/ - before and after lithium EEG in psych
patients – it causes slowing.
Nice review -
https://www.dovepress.com/brain-oscillations-in-bipolar-disorder-andnbsplithium-in
duced-changes-peer-reviewed-fulltext-article-NDT#ref43