Abstract
The central neurotoxicity of cyclosporin A (CsA) has been abundantly documented in pediatric and adult recipients of bone marrow or organ transplants, with variations in the rate of occurrence from 0.5% to 35%. We report two cases of central neurotoxicity ascribable to CsA in children with nephrotic syndrome due to lipoid nephrosis. The manifestations of CsA-related central neurotoxicity include confusion, aphasia, dystonias, akinetic mutism, parkinsonism, palsies, seizures, catatonia, coma, brain hemorrhage, and cortical blindness. Decreased density of the cerebral white matter is visible by computed tomography (CT) in 50% of cases, with the most commonly involved sites being the occipital cortex, the cerebellum, the periventricular substance, and the brainstem. Magnetic resonance imaging is more sensitive and more specific than CT for investigating the white matter. High-signal lesions are seen on T2-weighted sequences in the areas that are abnormal by CT. Many risk factors have been reported, including hypomagnesemia, hypocholesterolemia, high-dose glucocorticoid therapy, arterial hypertension, and infections. We present two patients with central neurotoxicity both of whom have elevated cholesterol levels.
Similar content being viewed by others
References
Hauben M (1996) Cyclosporine neurotoxicity. Pharmacotherapy 16:576–583
Niaudet P, and the French Society of Pediatric Nephrology (1994) Treatment of childhood steroid resistant idiopathic nephrosis with a combination of ciclosporine and prednisone. J Pediatr 125:981–985
McManus R, O’Hair D, Schweiger J, Beitzinger J, Siegel R (1992) Cyclosporine-associated central neurotoxicity after heart transplantation. Ann Thorac Surg 53:326–327
Bohlin AB, Berg U, Englund M, Malm G, Persson A, Tibell A, Tyden G (1990) Central nervous system complications in children treated with ciclosporin after renal transplantation. Child Nephrol Urol 10:225–230
Fryer J, Fortier M, Metrakos P, Verran D, Asfar S, Pelz D, Wall W, Grant D, Ghent C (1995) Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation. Transplantation 61:658–661
Cunnah D, Chew S, Wass J (1988) Cyclosporine for central nervous system sarcoidosis. Am J Med 85:580–581
Kutlay S, Savas S, Yalcin P, Ataman S, Ergin S (1997) Central nervous system toxicity of ciclosporin a treatment in rheumatoid arthritis. Br J Rheumatol 36:397–399
Shimizu C, Kimura S, Yoshida Y, Nezu A, Saitoh K, Osaka H, Aihara Y, Nagasaka Y (1994) Acute leucoencephalopathy during cyclosporin A therapy in a patient with nephrotic syndrome. Pediatr Nephrol 8:483–485
Kunzendorf U, Brockmöller J, Jochimsen F, Keller F, Walz G, Offermann G (1988) Cyclosporin metabolites and central-nervous-system toxicity. Lancet I:1223
Jeruss J, Braun SV, Reese JC, Guillot A (1998) Cyclosporine-induced white and grey matter central nervous system lesions in a pediatric renal transplant patient. Pediatr Transplant 2:45–50
Scheinman S, Reinitz E, Petro G, Schwartz R, Szmalc F (1990) Cyclosporine central neurotoxicity following renal transplantation: report of a case using magnetic resonance images. Transplantation 49:216–217
Gleeson JG, duPlessis AJ, Barnes PD, Riviello JJ Jr (1998) Cyclosporin A acute encephalopathy and seizure syndrome in childhood: clinical features and risk of seizure recurrence. J Child Neurol 13:336–344
Goldstein L, Haug M, Perl J, Perl M, Maurer J, Arroglia A, Mehta A, Kirby T, Higgins B, Stillwell P (1998) Central nervous system complications after lung transplantation. J Heart Lung Transplant 17:185–191
Bösmuller C, Steuterer W, Königsrainer A, Willeit J, Margreiter R (1991) Increased risk of central nervous toxicity in patients treated with ciclosporin and imipenem/cilastatin. Nephron 58:362–364
Bhatt B, Meriano F, Buchwald D (1988) Cyclosporine-associated central nervous system toxicity. N Engl J Med 31:788
Cooper DKC, Novitzky D, Davis L, Huff JE, Parker D, Schlesinger R, Sholer C, Zuhdi N (1989) Does central nervous system toxicity occur in transplant patients with hypocholesterolemia receiving cyclosporine? J Heart Transplant 8:221–224
Wong M, Yamada KA (2000) Cyclosporine induces epileptiform activity in an in vitro seizure model. Epilepsia 41:271–276
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Taque, S., Peudenier, S., Gie, S. et al. Central neurotoxicity of cyclosporine in two children with nephrotic syndrome. Pediatr Nephrol 19, 276–280 (2004). https://doi.org/10.1007/s00467-003-1347-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-003-1347-2