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Updated: Aug 15, 2026
09:24
Systemic Injection of Neural Stem/Progenitor Cells in Mice with Chronic EAE
Published on: April 15, 2014
Neurotoxicity of immunosuppressive drugs
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA. wijde@mayo.edu
Summary
Neurotoxicity from immunosuppressants like cyclosporine and tacrolimus presents differently now, with wider MRI abnormalities and new insights into blood-brain barrier dysfunction. Coma is now rare, but tremor and seizures persist.
Area of Science:
- Neuroscience
- Immunology
- Pharmacology
Background:
- The clinical presentation of neurotoxicity due to immunosuppressive agents has evolved.
- Cyclosporine and tacrolimus can cause a range of neurological symptoms, from tremor to seizures.
- Coma is now an uncommon manifestation of this neurotoxicity.
Purpose of the Study:
- To describe the changing clinical profile of neurotoxicity induced by immunosuppression.
- To detail the updated magnetic resonance imaging (MRI) findings associated with these toxicities.
- To explore recent evidence regarding the mechanisms of immunosuppressant-induced neurotoxicity.
Main Methods:
- Review of clinical cases and neuroimaging findings in patients treated with cyclosporine and tacrolimus.
- Analysis of recent scientific literature on the pathophysiology of immunosuppressant neurotoxicity.
- Examination of evidence related to drug-efflux pump inhibition and blood-brain barrier function.
Main Results:
- Neurotoxicity manifests in a spectrum including tremor, acute confusional state, status epilepticus, and speech abnormalities.
- MRI reveals widespread white matter lesions, potentially extending beyond the posterior lobes.
- Prolonged exposure can lead to apoptosis and cytotoxic edema, linked to nitric oxide production and blood-brain barrier dysfunction.
Conclusions:
- The neurotoxic effects of cyclosporine and tacrolimus have a shifting clinical and radiological profile.
- Understanding the mechanisms involving drug-efflux pumps and nitric oxide is crucial for managing neurotoxicity.
- Further research is needed to fully elucidate the complex pathophysiology and optimize patient outcomes.
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