Tóm tắt
Methotrexate (MTX)-associated neurotoxicity is a reported adverse event in pediatric oncology. We report 4 cases of neurological damage during MTX treatment (1 patient with lymphoma, 3 patients with acute leukemia) who were successfully treated with aminophylline. The time to onset of neurological symptoms after intrathecal MTX injection ranged from 7 to 124 days (mean 60 days). The initial symptoms in all patients were focal seizures, which progressed to status epilepticus and neurological deficits (impaired consciousness, motor paralysis). All patients had normal cerebrospinal fluid results; 3 patients had cortical and subcortical lesions on brain magnetic resonance imaging. All patients were treated with aminophylline combined with dextromethorphan, and all four had a reduction in seizures or became seizure-free within 24 hours of drug use, and neurological deficits (motor paralysis, decreased consciousness, vision) were restored. No adverse events were recorded during treatment. Neurotoxicity associated with MTX is a diagnosis that should be considered in children treated with MTX with new-onset neurological symptoms. Treatment with aminophylline and dextromethorphan is effective, especially when used early before brain lesions are detected on magnetic resonance imaging.
