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Subacute vocal cord paralysis, facial palsy and paraesthesias of lower limbs following surreptitious administration of disulfiram
  1. Narayana Manjunatha1,
  2. Rudhran Vidyendaran1,
  3. Mukund G Rao1,
  4. Girish Baburao Kulkarni2,
  5. Kesavan Muralidharan1,
  6. John P John1,
  7. B R Amar2,
  8. Sanjeev Jain1
  1. 1Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
  2. 2Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
  1. Correspondence to Dr Narayana Manjunatha, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India; manjunatha.adc{at}

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Disulfiram is a deterrent agent, prescribed to motivated patients, with their informed consent for the relapse prevention of alcohol dependence (AD).1 Supervised disulfiram treatment has proven efficacy for AD.1 There are reports of unregistered medical practitioners in India prescribing disulfiram surreptitiously.2

Neurotoxic side effects of disulfiram may be abrupt, in the form of fatigue, amnesia, confusion and behavioural changes; subacute in the form of ataxia, stupor, psychosis, seizure and encephalopathy; and chronic in the form of optic neuritis, ptosis and peripheral neuropathy.3 Previous reports of neurological sequelae with disulfiram have highlighted that a high dose of disulfiram, either supervised3 or as a single high-dose suicidal attempt,4 lead to these complications.

We report a case of subacute onset of neurological sequelae with therapeutic doses of disulfiram administered surreptitiously, without medical consultation and recovery within 6 weeks of stopping disulfiram.

Case report

A 32-year-old male, with family history of AD in one first-degree relative, personal history of nicotine dependence for 7 years and AD for 9 years presented with complaints of pain in both legs for 10 days, hoarseness of voice and drooping of both eyelids for 8 days.

On repeated enquiry, the patient's wife admitted to …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.