Abstract
Three patients developed akinetic mutism on the third day after the introduction of intravenous cyclosporin A, given for immunosuppression after liver transplantation. One patient in addition developed a florid orofacial dyskinesia, which resolved completely, as did the akinetic mutism, after withdrawal of cyclosporin. In these patients the time course of the akinetic mutism and extrapyramidal syndrome, which developed in the absence of any other identifiable cause, suggests cyclosporin A was the precipitating factor. Subsequently, two of the patients showed signs of pseudobulbar palsy with abnormalities in the pons on MRI scanning, suggesting central pontine myelinolysis (CPM). None of the patients had experienced significant fluctuations in serum sodium or other risk factors for central pontine myelinolysis and the exact relationship to the earlier cyclosporin related mutism was not clear.
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- Devinsky O., Lemann W., Evans A. C., Moeller J. R., Rottenberg D. A. Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study. Arch Neurol. 1987 Apr;44(4):414–417. doi: 10.1001/archneur.1987.00520160048013. [DOI] [PubMed] [Google Scholar]
- Estol C. J., Faris A. A., Martinez A. J., Ahdab-Barmada M. Central pontine myelinolysis after liver transplantation. Neurology. 1989 Apr;39(4):493–498. doi: 10.1212/wnl.39.4.493. [DOI] [PubMed] [Google Scholar]
- Grigg M. M., Costanzo-Nordin M. R., Celesia G. G., Kelly M. A., Silver M. A., Sobotka P. A., Robinson J. A. The etiology of seizures after cardiac transplantation. Transplant Proc. 1988 Jun;20(3 Suppl 3):937–944. [PubMed] [Google Scholar]
- Lavenstein B., Stewart C., Tina L. U. Cyclosporine-associated encephalopathy in childhood transplant patients. Transplant Proc. 1988 Jun;20(3 Suppl 3):285–287. [PubMed] [Google Scholar]
- Lucey M. R., Kolars J. C., Merion R. M., Campbell D. A., Aldrich M., Watkins P. B. Cyclosporin toxicity at therapeutic blood levels and cytochrome P-450 IIIA. Lancet. 1990 Jan 6;335(8680):11–15. doi: 10.1016/0140-6736(90)90137-t. [DOI] [PubMed] [Google Scholar]
- Rubin A. M., Kang H. Cerebral blindness and encephalopathy with cyclosporin A toxicity. Neurology. 1987 Jun;37(6):1072–1076. doi: 10.1212/wnl.37.6.1072. [DOI] [PubMed] [Google Scholar]
- Thompson P. D., Miller D., Gledhill R. F., Rossor M. N. Magnetic resonance imaging in central pontine myelinolysis. J Neurol Neurosurg Psychiatry. 1989 May;52(5):675–677. doi: 10.1136/jnnp.52.5.675. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wiener J., Kennedy S. Akinesia and mutism following a methylphenidate challenge test. J Clin Psychopharmacol. 1985 Aug;5(4):231–233. [PubMed] [Google Scholar]
- de Groen P. C., Aksamit A. J., Rakela J., Forbes G. S., Krom R. A. Central nervous system toxicity after liver transplantation. The role of cyclosporine and cholesterol. N Engl J Med. 1987 Oct 1;317(14):861–866. doi: 10.1056/NEJM198710013171404. [DOI] [PubMed] [Google Scholar]