Bottled lightning

Minerva recently drew the attention of readers of the BMJ to a report of a symptom that patients have described as “brain shivers”—attributed to venlafaxine and other antidepressants and also after venlafaxine withdrawal.¹ Other terms that have been used to describe this symptom are “electric brain thingies,” “brain zaps,” and “brain flips.”

The author of the report traced the earliest use of the term “brain shivers” to 1999, but the symptom is not perhaps as new as that. It may be the same as the symptoms of electric shocks and fizzing in the head that others have described since the early 1980s. When Medawar and Herxheimer surveyed 1370 transcripts of Yellow Card reports of adverse events after withdrawal of paroxetine submitted to the Medicines and Healthcare products Regulatory Agency (MHRA) between 1990 and 2002 they discovered 56 cases of electric shock sensations in the head.² Similar cases were reported in 1998.³ But those who are familiar with the literature on monoamine oxidase inhibitors will recall that in 1980 the same symptom, in some cases relieved by pyridoxine,⁴ was described in patients taking phenelzine.⁵

Nevertheless, these symptoms are not well recognised by doctors. For example, if you search PubMed for the term “brain shivers” you won't find it. And in some of the transcribed Yellow Card reports that Medawar and Herxheimer surveyed, the term “electric shock” was interpreted as if it meant paraesthesia or something to do with injury through exposure to mains electricity. When the Medicines Control Agency first surveyed 78 Yellow Card reports of symptoms that occurred after the withdrawal of paroxetine, they listed them as including dizziness, sweating, nausea, insomnia, tremor, and confusion.⁶ But among the earliest 78 Yellow Cards that they surveyed, Medawar and Herxheimer identified five reports of “electric shock” sensations—more than for insomnia (3 reports), tremor (3), or confusion (2).

If this symptom is to be recognised and recorded properly we need to give it a name that doctors will respect, and that means one that is based on Latin or Greek. If the symptoms of electric shocks, fizzing, and brain shivers represent some kind of random discharge of nerve impulses in the brain, lightning would be an appropriate metaphor to use.

The words for lightning in different languages show an amazing range, even across those that are Indo-European in origin—for example, Blitz (German), lampo (Italian), lynglimt (Danish), and foudre (French). An alternative French word is éclair, like the cake, famously defined in Chambers Dictionary as being “long in shape and short in duration”; indeed, just like lightning. In Latin, lightning was fulgur or sometimes fulmen, from which we get effulgent and fulminant. And the classical Greek word was astrapē, a word that was used to describe both lightning in the sky and metaphorical lightning in the eyes and as an epithet for Zeus.

I therefore suggest neurastrapy, which simply means “nerve lightning” or perhaps encephalastrapy, brain lightning. We shall certainly need such a term when somebody does a placebo controlled trial of pyridoxine.