—The precise role of neuroleptics in the development of permanent neurologic damage due to lithium carbonate has been debated since Cohen and Cohen1 first reported the association. This is elaborated in detail in our article2 along with a possible mechanism for increased toxicity when these agents are combined. It would be wrong, however, to overemphasize this as neuroleptics and lithium carbonate are often prescribed together and may thus be expected to be associated in cases of this type. As we have outlined, other factors may also be important.
Some of the patients who sustained permanent neurologic damage were prescribed doses that were inappropriately large. Others, however, were maintained on conventional doses for long periods and only manifested signs of toxicity when an event occurred to destabilize the situation (eg, infection, dehydration, deterioration in renal function, or the addition of new drugs). Whether one regards the patients as having
Donaldson IM. Lithium Salt Intoxication and Neurologic Sequelae-Reply. Arch Neurol. 1984;41(9):916. doi:10.1001/archneur.1984.04050200018008
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