Is terminal restlessness sometimes drug induced?

Abstract

The case history of a terminally ill patient who developed continuous myoclonic jerking while comatose is presented. The potential for high dose opioids to produce central nervous system excitation, including twitching, myoclonic jerking and seizures, is highlighted. Attention is drawn to the possible contributory effects of phenothiazines and antihistamines by virtue of their ability to lower seizure threshold. The use of phenobarbitone to control such phenomena is suggested, and a brief review of other anticonvulsants which may be considered in palliative care is included.