EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement

Lisbeth Samsø Schmidt; Troels W Kjær; Kjeld Schmiegelow; Alfred Peter Born

doi:10.1016/j.ejpn.2017.05.008

EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement

Lisbeth Samsø Schmidt, Troels W Kjær, Kjeld Schmiegelow, Alfred Peter Born

Department of Clinical Medicine

5 Citations (Scopus)

Abstract

Sub-acute neurotoxicity is a well-known complication to high-dose and intrathecal methotrexate (MTX) treatment of children with leukemia. Symptoms can be treated safely by dextromethorphan, a non-competitive antagonist to N-methyl-D-aspartic acid receptor (NMDAR). In a female with subacute MTX neurotoxicity, we observed an electroencephalographic (EEG) with extreme delta brush. Extreme delta brush is an EEG pattern previously described in patients with NMDAR autoimmune encephalitis. The observations suggest that the mechanism of this neurotoxicity may be mediated by the NMDAR. Furthermore, extreme EEG delta brush should suggest a diagnosis of MTX associated subacute neurotoxicity.

Original language	English
Journal	European Journal of Paediatric Neurology
Volume	21
Issue number	5
Pages (from-to)	795-797
ISSN	1090-3798
DOIs	https://doi.org/10.1016/j.ejpn.2017.05.008
Publication status	Published - Sept 2017

Keywords

Adolescent
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/chemically induced
Antimetabolites, Antineoplastic/adverse effects
Dextromethorphan/therapeutic use
Electroencephalography
Female
Humans
Methotrexate/adverse effects
Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors

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10.1016/j.ejpn.2017.05.008

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@article{9087d3fe677447cea8d980f536753ac4,

title = "EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement",

abstract = "Sub-acute neurotoxicity is a well-known complication to high-dose and intrathecal methotrexate (MTX) treatment of children with leukemia. Symptoms can be treated safely by dextromethorphan, a non-competitive antagonist to N-methyl-D-aspartic acid receptor (NMDAR). In a female with subacute MTX neurotoxicity, we observed an electroencephalographic (EEG) with extreme delta brush. Extreme delta brush is an EEG pattern previously described in patients with NMDAR autoimmune encephalitis. The observations suggest that the mechanism of this neurotoxicity may be mediated by the NMDAR. Furthermore, extreme EEG delta brush should suggest a diagnosis of MTX associated subacute neurotoxicity.",

keywords = "Adolescent, Anti-N-Methyl-D-Aspartate Receptor Encephalitis/chemically induced, Antimetabolites, Antineoplastic/adverse effects, Dextromethorphan/therapeutic use, Electroencephalography, Female, Humans, Methotrexate/adverse effects, Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors",

author = "Schmidt, {Lisbeth Sams{\o}} and Kj{\ae}r, {Troels W} and Kjeld Schmiegelow and Born, {Alfred Peter}",

year = "2017",

month = sep,

doi = "10.1016/j.ejpn.2017.05.008",

language = "English",

volume = "21",

pages = "795--797",

journal = "European Journal of Paediatric Neurology",

issn = "1090-3798",

publisher = "Elsevier",

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TY - JOUR

T1 - EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement

AU - Schmidt, Lisbeth Samsø

AU - Kjær, Troels W

AU - Schmiegelow, Kjeld

AU - Born, Alfred Peter

PY - 2017/9

Y1 - 2017/9

N2 - Sub-acute neurotoxicity is a well-known complication to high-dose and intrathecal methotrexate (MTX) treatment of children with leukemia. Symptoms can be treated safely by dextromethorphan, a non-competitive antagonist to N-methyl-D-aspartic acid receptor (NMDAR). In a female with subacute MTX neurotoxicity, we observed an electroencephalographic (EEG) with extreme delta brush. Extreme delta brush is an EEG pattern previously described in patients with NMDAR autoimmune encephalitis. The observations suggest that the mechanism of this neurotoxicity may be mediated by the NMDAR. Furthermore, extreme EEG delta brush should suggest a diagnosis of MTX associated subacute neurotoxicity.

AB - Sub-acute neurotoxicity is a well-known complication to high-dose and intrathecal methotrexate (MTX) treatment of children with leukemia. Symptoms can be treated safely by dextromethorphan, a non-competitive antagonist to N-methyl-D-aspartic acid receptor (NMDAR). In a female with subacute MTX neurotoxicity, we observed an electroencephalographic (EEG) with extreme delta brush. Extreme delta brush is an EEG pattern previously described in patients with NMDAR autoimmune encephalitis. The observations suggest that the mechanism of this neurotoxicity may be mediated by the NMDAR. Furthermore, extreme EEG delta brush should suggest a diagnosis of MTX associated subacute neurotoxicity.

KW - Adolescent

KW - Anti-N-Methyl-D-Aspartate Receptor Encephalitis/chemically induced

KW - Antimetabolites, Antineoplastic/adverse effects

KW - Dextromethorphan/therapeutic use

KW - Electroencephalography

KW - Female

KW - Humans

KW - Methotrexate/adverse effects

KW - Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors

U2 - 10.1016/j.ejpn.2017.05.008

DO - 10.1016/j.ejpn.2017.05.008

M3 - Journal article

C2 - 28655493

SN - 1090-3798

VL - 21

SP - 795

EP - 797

JO - European Journal of Paediatric Neurology

JF - European Journal of Paediatric Neurology

IS - 5

ER -

EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement

Abstract

Keywords

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