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Cyclosporine-A-Based Immunosuppressive Therapy-Induced Neurotoxicity: A Case Report

机译：基于环孢菌素-A的免疫抑制治疗诱导的神经毒性：案例报告

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Cyclosporine-A (CsA) and mycophenolate mofetil are immunosuppressive drugs used for the prevention of transplant rejection. Various clinical studies have been performed on different forms of CsA neurotoxicity, including tremor, paresthesia, confusion, ataxia, neuralgia, hemiplegia, occipital seizures, and transient cortical blindness. Mycophenolate is associated with several neurological side effects including headache, insomnia, dizziness, depression, confusion, hypertonia, and paresthesia. A 31-year-old male with a history of kidney transplantation was treated with CsA and mycophenolate mofetil, for 18 years. He had been referred to the emergency department with complaints of generalized tonic-clonic seizure for 1 minute and 15 minutes of the post-ictal phase. Almost all laboratory tests including cerebrospinal fluid analysis were within normal limits. Brain MRI findings were compatible with CsA-based neurotoxicity. The patient’s symptoms and MRI findings improved on decreasing CsA to the minimum dose. CsA neurotoxicity is more common in intravenous therapy, early days of CsA administration, P450 inhibitors administration, and following liver transplantation. MRI findings in CsA neurotoxicity include signal changes in the cerebral cortex and juxtacortical white matter of the occipital lobes, temporal, parietal, and frontal lobes. Every year, many solid organ transplantations are performed. Many of these patients received CsA-based regimens for the prevention of rejection. Therefore, it is necessary to consider CsA neurotoxicity in suspected patients.
机译：环孢菌素-A（CSA）和霉酚酸酯Mofetil是用于预防移植排斥的免疫抑制药物。对不同形式的CSA神经毒性进行了各种临床研究，包括震颤，热敏，混乱，共济失调，神经痛，偏瘫，枕脑癫痫发作和瞬态皮质失明。霉酚酸与几种神经系统副作用有关，包括头痛，失眠，头晕，抑郁症，混乱，过高症和感觉。一名31岁的男性患有肾移植历史的历史，用CSA和霉酚酸酯Mofetil治疗，18年。他已被提交给急诊部门的急救症，普遍滋补克隆癫痫发作1分钟，15分钟的后ICTAL阶段。几乎所有实验室测试，包括脑脊液分析都在正常限制范围内。脑MRI调查结果与基于CSA的神经毒性相容。患者的症状和MRI调查结果改善了降低CSA至最小剂量。 CSA神经毒性在静脉治疗中更常见，CSA给药初期，P450抑制剂给药，以及肝移植后。 CSA神经毒性的MRI发现包括枕骨裂片，颞叶，颞叶和额叶的脑皮质和左底白物的信号变化。每年，进行许多固体器官移植。其中许多患者接受了基于CSA的预防抑制的方案。因此，有必要考虑疑似患者的CSA神经毒性。

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