Shridhar Sharma: Insulin coma treatment: Facts and controversies

Shridhar Sharma’s reply to Vimal K. Razdan’s comment

            I am thankful for your comments on my essay on Insulin Coma Treatment (ICT). Yes, you are right that I was actively involved with ICT and also with tolbutamide. In so far as tolbutamide is concerned, we did not find that it had any effect on schizophrenia. Patients treated with tolbutamide gained weight. It did not induce coma/sub-coma.

You have also long and rich experience with ICT but probably you have not done any controlled studies to support your claims. Yet your observations are important.

 I agree with you that ICT for various reasons had a ‘premature death’.

 With regard to the relationship between epilepsy and schizophrenia, and the relationship between seizures and the effectiveness of ICT, please note the findings of Vonberg and Bigdeli (2016) which suggest genetic connection between epilepsy and schizophrenia. Dedeurwaerdere et al (2015) postulated that dysfunctions in glutamatergic neurotransmission could possibly be a common pathomechanism for both. They also suggest that a major negative feedback system is regulated by presynaptic group II metabotropic glutamate (mGlu) receptors including mGlu 2/3. As these receptors are predominantly localized extra-synaptically in basal ganglia and limbic structures they are targets for the treatment of both disorders. I would like to add that for some time the involvement of the hippocampus has been considered in the pathophysiology of both epilepsy and schizophrenia. This is in keeping with reports that temporal lobe epilepsy (TLE) and psychosis coexist frequently (Kandratavicius et al, 2014).

References:

Dedeurwaerdere S, Boets S, Janssens P, Lavreysen H, Steckler T. In the grey zone

between epilepsy and schizophrenia: alterations in group II metabotropic glutamate

receptors. Acta Neurol Belg.2015; 115: 221-32.

Kandratavicious L, Hallak JE, Leite JP. What are the similarities and differences between

schizophrenia and schizophrenia-like psychosis of epilepsy? A neuropathological

approach to the understanding of schizophrenia spectrum and epilepsy. Epilepsy Behav.

2014 Sep; 38:143-7.

Vonberg FW, Bigdeli TB. Genetic Correlation between Schizophrenia and Epilepsy JAMA

Neurol. 2016 Jan 1; 73(1): 125-6.

Shridhar Sharma

August 25, 2016