Presentation
Abstract We present a 1 7-year-old female with acute extra-pyramidal parkinsonism complicating a suicidal attempt with the organophosphate insecticide chlorpyrifos, who was initially suspected to have developed severe depression or psychosis. [ncbi.nlm.nih.gov]
Entire Body System
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Fatigue
Other adverse health effects caused by pesticides include chronic fatigue, asthma, wheeze, immune system disorders, impaired memory, disorientation, depression, irritability, flu-like symptoms, and may increase risk of cancer and Alzheimer's disease. [gdx.net]
Muscle weakness, fatigue. Vomiting, diarrhoea, urination. Severe Pinpoint pupils. Confusion and agitation. Convulsions. Copious excess secretions. Cardiac arrhythmias. Collapse, respiratory depression or respiratory arrest. Coma. Death. [patient.info]
[…] muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue [healthline.com]
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Unconsciousness
Role of oximes in organophosphate poisoning--a case report A 28-year-old man was found unconscious. [acronymfinder.com]
Maximum duration of unconsciousness was between 4-5 hours, the interval was, in 60% of cases, within 1-2 hours and in 30% if cases, 2-6 hours and 10% between 6-12 hours. [jpma.org.pk]
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Rigor
Although IMS is well recognized as a disorder of neuromuscular junctions, its exact etiology, incidence, and risk factors are not clearly defined because existing studies are largely small-scale case series and do not employ a consistent and rigorous [ncbi.nlm.nih.gov]
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Asymptomatic
The patient is presently maintained on amantadine therapy; there was mild worsening of her extrapyramidal signs following unplanned discontinuation of this medication, and on follow-up assessments after 9 months she is virtually asymptomatic. [ncbi.nlm.nih.gov]
Respiratoric
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Bronchorrhea
Treat supportively by giving atropine to relieve bronchospasm and bronchorrhea and by giving 2-PAM to relieve neuromuscular symptoms. [merckmanuals.com]
Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures. Immediate aggressive use of atropine may eliminate the need for intubation. [openanesthesia.org]
By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools. [omicsgroup.org]
sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal cramps, and diarrhea. [clinicaladvisor.com]
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Rhinorrhea
sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal cramps, and diarrhea. [clinicaladvisor.com]
Gastrointestinal
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Vomiting
[…] of parenteral injection of organophosphates, attention must be paid to the possibility of late onset of the clinical manifestations of the poisoning, and to the fact that usual measures to reduce exposure to the organophosphate, such as induction of vomiting [ncbi.nlm.nih.gov]
Shortly thereafter, the boy's 10-year-old sister, with the exact same unpleasant odour, altered sensorium, vomiting and respiratory distress, was brought to the emergency department by the father. [intjem.springeropen.com]
School authorities stopped serving the meal once the children began vomiting. The school's principal, who went into hiding after the incident, was arrested Tuesday. [cbsnews.com]
Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant. [pbs.org]
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Diarrhea
Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant. [pbs.org]
Here are a few: vomiting, diarrhea, seizures, paralysis, coma, and death. And, this is all caused by messing with a single hydroxyl (OH) group, which is a tiny, but critical portion (the "business end") of acetylcholinesterase. [acsh.org]
Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic. [medlineplus.gov]
[…] samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache Dizziness Muscle twitching Poor coordination Vomiting Diarrhea [gdx.net]
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Nausea
Nausea. Mild muscle weakness. Localised muscle twitching. Mild agitation. Moderate Pinpoint pupils, conjunctival injection. Dizziness, disorientation. Coughing, wheezing, sneezing. Drooling, excess phlegm, bronchorrhoea, bronchospasm. [patient.info]
Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic. [medlineplus.gov]
[…] metabolized into the six dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea [gdx.net]
Clinically, the patient exhibits excessive salivation, nausea, vomiting, diarrhea, abdominal cramping, and asthmatic symptoms related to a combination of bronchoconstriction and increased respiratory secretions. [path.upmc.edu]
Mild organophosphate exposure may cause: narrowed, pinpointed pupils impaired, blurry vision stinging eyes runny nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure [healthline.com]
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Abdominal Cramps
Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant. [pbs.org]
During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of [projecttendr.com]
Clinically, the patient exhibits excessive salivation, nausea, vomiting, diarrhea, abdominal cramping, and asthmatic symptoms related to a combination of bronchoconstriction and increased respiratory secretions. [path.upmc.edu]
Vomiting, abdominal cramps, excessive cold sweating and salivation follow. Giddiness and restlessness may be noticeable. Constriction of the pupils is not always present. [jpma.org.pk]
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Abdominal Pain
Listing individual symptoms emphasized the high prevalence of nonspecific symptoms such as vomiting (142 cases) and abdominal pain (115 cases). [ncbi.nlm.nih.gov]
Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic. [medlineplus.gov]
The most frequent signs are reported to be meiosis, vomiting, hypersalivation, respiratory distress, abdominal pain, and depressed level of consciousness and muscle fasciculation [ 10 ]. [ccforum.biomedcentral.com]
Jaw & Teeth
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Hypersalivation
The most frequent signs were meiosis, change in mental status, hypersalivation and fasciculations. Ten patients (21.2%) required mechanical ventilation. [ncbi.nlm.nih.gov]
The most frequent clinical signs were meiosis, change in mental status, hypersalivation, agitation and fasciculations (Table 2 ). [ccforum.biomedcentral.com]
The physical examination of the boy showed pinpoint pupils (2 mm diameter), hypersalivation and lacrimation. He was responsive to pain, but had slurred speech. His Glasgow Coma Scale (GCS) score was 9. [intjem.springeropen.com]
Cardiovascular
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Tachycardia
Tachycardia, rather than bradycardia, has been noted upon presentation in 49% of children presenting with OI [ 6 ]. [intjem.springeropen.com]
Tachycardia and mydriasis must not be used to limit or to stop subsequent doses of atropine. The main concern with OP toxicity is respiratory failure from excessive airway secretions. [openanesthesia.org]
Two patients who are mechanically ventilated died with sudden car-diorespiratory arrest following ventricular tachycardia, and three died from pneumonia and complicating adult respiratory distress syndrome. [ccforum.biomedcentral.com]
Tachycardia, rather than bradycardia, has been noted upon presentation in 49% of children presenting with organophosphate intoxication [ 14 ]. Organophosphate intoxications mostly occur in suicidal intent or by accident. [omicsgroup.org]
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Hypotension
Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. [openanesthesia.org]
Most patients have bradycardia and, if poisoning is severe, hypotension. CNS toxicity is common, sometimes with seizures and excitability and often with lethargy and coma. [merckmanuals.com]
[…] within 4 - 24 hours of contact): headache, sweating, tearing, drooling, vomiting, tunnel vision, and twitching; In severe cases (after continued daily absorption): abdominal cramps, urinating, diarrhea, muscular tremors, staggering gait, pinpoint pupils, hypotension [pmep.cce.cornell.edu]
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Hypertension
A wide range of other symptoms may also be noted, including incontinence, defecation, tachycardia, bradycardia, hypertension, cramping of skeletal muscles, bronchospasm, and pulmonary edema. [clinicaladvisor.com]
Musculoskeletal
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Muscle Twitch
[…] include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue severe vomiting and diarrhea involuntary urination and defecation [healthline.com]
[…] dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache Dizziness Muscle [gdx.net]
There can be many symptoms, though they may not be as clear-cut in children as they are in adults: blurred vision; tearing and sweating; loss of bowel and bladder control; difficulty breathing, as the airway may fill with fluid; tremors, muscle twitching [poison.org]
Muscle Twitching and Fasciculations These two are not seen with Flit (2% chlordane with kerosene). Further therapeutic improvement with Atropine Sulphate in cases of organophosphorus insecticides is diagnostic. [jpma.org.pk]
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Skeletal Muscle Fasciculation
Nicotinic manifestations include increased or decreased muscle power and skeletal muscle fasciculations. Muscarinic manifestations include excessive salivation, meiosis and diarrhea. [ccforum.biomedcentral.com]
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Myopathy
[…] cholinergic receptors, muscle necrosis, prolonged acetylcholinesterase inhibition, inadequate oxime therapy, downregulation or desensitization of postsynaptic acetylcholine receptors, failure of postsynaptic acetylcholine release, and oxidative stress-related myopathy [ncbi.nlm.nih.gov]
Eyes
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Miosis
The pupillary response (resolution of miosis) is not considered an end point of atropine therapy, as miosis may persist for weeks after significant exposure [ 11 ]. [intjem.springeropen.com]
Miosis 2. Muscle Twitching and Fasciculations These two are not seen with Flit (2% chlordane with kerosene). Further therapeutic improvement with Atropine Sulphate in cases of organophosphorus insecticides is diagnostic. [jpma.org.pk]
Miosis is commonly observed, as are symptoms of central nervous system (CNS) toxicity, such as anxiety and restlessness. Pediatric patients often present with a slightly different clinical picture. [clinicaladvisor.com]
Therefore signs such as miosis, increased secretion, bronchospasm, incontinence in urine and stool appeared after a short period. Atropine and the enzyme reactivator obidoxime were given as antidotal therapy for this poisoning. [omicsgroup.org]
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Blurred Vision
Painful, blurred vision. Runny nose and eyes. Excess saliva. Eyes looking 'glassy'. Headache. Nausea. Mild muscle weakness. Localised muscle twitching. Mild agitation. Moderate Pinpoint pupils, conjunctival injection. Dizziness, disorientation. [patient.info]
Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant. [pbs.org]
Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. [openanesthesia.org]
There can be many symptoms, though they may not be as clear-cut in children as they are in adults: blurred vision; tearing and sweating; loss of bowel and bladder control; difficulty breathing, as the airway may fill with fluid; tremors, muscle twitching [poison.org]
Psychiatrical
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Stereotyped Behavior
When children were eight years old, we administered the Social Responsiveness Scale (SRS), a continuous measure of various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behaviors. [ncbi.nlm.nih.gov]
Neurologic
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Confusion
Confusion and agitation. Convulsions. Copious excess secretions. Cardiac arrhythmias. Collapse, respiratory depression or respiratory arrest. Coma. Death. [patient.info]
Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant. [pbs.org]
His 2016 article, "Six Charts Designed to Confuse You," is the seminal work on CDC deception and has been adopted by patient advocacy groups and individuals and has been sent to governors and state legislatures. Dr. [acsh.org]
During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of [projecttendr.com]
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Seizure
Here are a few: vomiting, diarrhea, seizures, paralysis, coma, and death. And, this is all caused by messing with a single hydroxyl (OH) group, which is a tiny, but critical portion (the "business end") of acetylcholinesterase. [acsh.org]
Benzodiazepines are used for seizures. Prophylactic diazepam may help prevent neurocognitive sequelae after moderate to severe organophosphate poisoning. [merckmanuals.com]
Paralysis may mask seizures. Consider electroencephalogram (EEG) monitoring. [patient.info]
During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of [projecttendr.com]
Drugs can also be given to combat the delirium and seizures associated with the pesticide. [cbsnews.com]
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Tremor
[…] toxogonin treatment along with mechanical ventilation she developed overt extrapyramidal parkinsonism and encephalopathy, characterized by impaired sensorium and agitation, mask facies along with a muffled voice and swallowing impairment, a resting tremor [ncbi.nlm.nih.gov]
On day 6, the patient developed rigidity and bradykinesia, with tremor both hands. He was conscious and oriented to commands. [ijnpnd.com]
Marked muscle twitching or tremors. Muscle weakness, fatigue. Vomiting, diarrhoea, urination. Severe Pinpoint pupils. Confusion and agitation. Convulsions. Copious excess secretions. Cardiac arrhythmias. [patient.info]
In higher doses, people may suffer from vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, slurred speech, loss of reflexes, twitching, tremors of the tongue or eyelids, and eventually, paralysis of the body extremities and the [pbs.org]
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Headache
These solvents can lead to symptoms too, including headache and nausea. Lipophilic compounds can cause delayed or persistent toxicity as they slowly move out of the tissues. Remember that accurate, contemporaneous notes are essential. [patient.info]
The patient's symptoms, the recovery after atropine administration and the occurrence of headache in the involved health care personnel indicated probable OI. [intjem.springeropen.com]
[…] metabolized into the six dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache [gdx.net]
Chronic exposure may lead to disorientation, severe depression, irritability, confusion, headache, speech difficulties, delayed reaction times, nightmares, sleepwalking and drowsiness or insomnia, as well as numbness, cramping and weakness in the legs [pbs.org]
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Irritability
Rapid-onset eye and/or skin irritation with rapid or delayed respiratory symptoms. Could this be chlorine, other irritant gas, or a riot control agent? Exposure to pungent greenish yellow gas (chlorine) or other irritant. [patient.info]
Other adverse health effects caused by pesticides include chronic fatigue, asthma, wheeze, immune system disorders, impaired memory, disorientation, depression, irritability, flu-like symptoms, and may increase risk of cancer and Alzheimer's disease. [gdx.net]
Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest. [omicsgroup.org]
Chronic exposure may lead to disorientation, severe depression, irritability, confusion, headache, speech difficulties, delayed reaction times, nightmares, sleepwalking and drowsiness or insomnia, as well as numbness, cramping and weakness in the legs [pbs.org]
Workup
See Workup. Treatment begins with decontamination. Airway control and oxygenation are paramount. The mainstays of pharmacological therapy include atropine, pralidoxime (2-PAM), and benzodiazepines (eg, diazepam). [emedicine.medscape.com]
Serum
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Base Deficit
Several studies have demonstrated that the base deficit (BD) is a prognostic tool that is correlated with the severity of injury and predicted mortality, particularly in trauma patients. [ncbi.nlm.nih.gov]
Rhythm
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Torsades De Pointes
Torsades de Pointes should be treated in the standard manner. The use of intravenous magnesium sulfate has been reported as beneficial for organophosphate toxicity. [openanesthesia.org]
Treatment
The signs and symptoms of acute poisoning are described and a rational approach to specific treatment is discussed. [ncbi.nlm.nih.gov]
Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. British Journal of Clinical Pharmacology. 2015; 81(3):462–70. doi: 10.1111/bcp.12784 [journals.sbmu.ac.ir]
Prognosis
The prognosis of IMS, however, is likely to be favorable if respiratory failure can be promptly recognized and treated accordingly. [ncbi.nlm.nih.gov]
RBC cholinesterase level correlates better with severity and prognosis or a mixed cholinesterase ratio is best for determining if sufficient pralidoxime is being given. [patient.info]
Lancet 2008, 371: 597–607. 10.1016/S0140-6736(07)61202-1 PubMed Central View Article PubMed Google Scholar Aygun D: Serum acetylcholinesterase and prognosis of acute organophosphate poisoning. [intjem.springeropen.com]
Aygun D, Doganay Z, Altinop L, Guven H, Onar M, et al. (2002) Serum acetylcholinesterase and prognosis of acute organophosphate poisoning.J Toxicol Clin Toxicol 40: 903–910. Leibson T, Lifshitz M (2008) Organophosphate and carbamate poisoning. [omicsgroup.org]
Etiology
Although IMS is well recognized as a disorder of neuromuscular junctions, its exact etiology, incidence, and risk factors are not clearly defined because existing studies are largely small-scale case series and do not employ a consistent and rigorous [ncbi.nlm.nih.gov]
The etiology of parkinsonism is multifactorial, with both genetic and environmental determinants. The development of typical parkinsonism following brief inhalational OPI exposure is very rare and there are only a few reports in the literature. [ijnpnd.com]
Epidemiology
BACKGROUND AND AIM: Epidemiological studies linking insecticide exposure to childhood neurodevelopment have been gaining global attention. [ncbi.nlm.nih.gov]
Describes everything you need to know about Organophosphates and Carbamates Extensively covers pesticides, nerve agents, therapeutic drugs, and flame retardants Describes epidemiology of the world's major disasters involving Organophosphates and Carbamates [books.google.com]
An epidemiological study of poisoning in northern Islamic Republic of Iran. Eastern Mediterranean Health Journal. 2002; 8(1):88-94. PMID: 15330564 Nambiar MP, Gordon RK, Rezk PE, Katos AM, Wajda NA, Moran TS, et al. [journals.sbmu.ac.ir]
Pathophysiology
Despite a high incidence, the pathophysiology that underlies IMS remains unclear. [ncbi.nlm.nih.gov]
These have included difficulties in executive functions, psychomotor speed, verbal, memory, attention, processing speed, visual-spatial functioning, and coordination. [4] Pathophysiology The primary mechanism of action of organophosphate pesticides is [emedicine.medscape.com]
Prevention
Thus, administration of a drug such as amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae. [ncbi.nlm.nih.gov]
Successful examples include reducing dust in orchards to prevent the buildup of spider mites, and the cleanup of unharvested grapes to limit overwintering pests. * Less toxic, more pest-specific alternative insecticides, such as pyrethroids, neonicotinoids [sciencedaily.com]
In severe cases, doctors often prescribe benzodiazepines to prevent or stop seizures. [healthline.com]