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Cyclosporine neurotoxicity: a review
J M Gijtenbeek1, M J van den Bent, C J Vecht
1Department of Neuro-oncology, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Journal of Neurology
|July 10, 1999
Summary
Cyclosporin A (CsA) causes significant neurological side effects, including reversible posterior leukoencephalopathy syndrome, in many patients. Symptoms often resolve with dose reduction or CsA withdrawal.
Area of Science:
- Neuroscience
- Immunology
- Pharmacology
Background:
- Cyclosporin A (CsA) is an immunosuppressant medication with known neurological side effects.
- Up to 40% of patients treated with CsA experience adverse neurological events.
- Reversible posterior leukoencephalopathy syndrome (RPLS) is a severe complication of CsA therapy.
Purpose of the Study:
- To review the spectrum of neurological side effects associated with Cyclosporin A.
- To discuss potential mechanisms underlying CsA-induced neurotoxicity.
- To highlight the clinical presentation and management of CsA neurotoxicity.
Main Methods:
- Review of clinical literature on Cyclosporin A neurotoxicity.
- Analysis of reported symptoms, neuroimaging findings, and potential contributing factors.
- Examination of treatment outcomes related to CsA dose modification.
Main Results:
- Common CsA neurotoxicities include tremor, encephalopathy, seizures, visual disturbances, and peripheral neuropathy.
- Hypertension, hypomagnesemia, and endothelin may contribute to CsA neurotoxicity.
- Neurotoxicity can occur even with therapeutic CsA blood levels and is associated with white matter changes.
Conclusions:
- Cyclosporin A poses a significant risk of neurological adverse effects.
- Early recognition and management, including dose adjustment, are crucial for symptom resolution.
- Further research into the pathogenesis of CsA neurotoxicity is warranted.