Department of Neurology, Shaare Zedek Medical Center and Faculty of Health Sciences, Ben-Gurion University, Jerusalem 91031, Israel.
Environ Toxicol Pharmacol. 2005 May;19(3):721-5. doi: 10.1016/j.etap.2004.12.031. Epub 2005 Jan 26.
The neurotoxicity of methotrexate (MTX) is more severe when administered intrathecally (IT) than by the oral and intravenous (IV) routes, and has been reported even with a single administration of therapeutic doses of 12 or 15mg. Prompt recognition and treatment are essential to improve the outcome after massive IT-MTX overdose. Treatment options include CSF drainage or CSF exchange, ventriculolumbar perfusion, IT corticosteroids to reduce CSF inflammation and IV leucovorin to reduce systemic toxicity. Toxicity resulting from IT injection of leucovorin is controversial. CSF drainage and exchange are particularly effective if performed soon after the overdose. In this paper we describe a protocol of treatment for severe cases of IT-MTX overdose in excess of 100mg. The mainstay of treatment is dilution and removal from CSF of excessive methotrexate alongside with specific antidotal therapy.
鞘内（IT）给予甲氨蝶呤（MTX）比口服和静脉（IV）途径更具神经毒性，甚至单次给予治疗剂量 12 或 15mg 也会发生。在 MTX 鞘内大剂量过量后，及时识别和治疗对于改善预后至关重要。治疗选择包括腰穿脑脊液引流或脑脊液交换、脑室灌洗、鞘内皮质类固醇以减少脑脊液炎症和 IV 亚叶酸钙以减少全身毒性。鞘内注射亚叶酸钙引起的毒性存在争议。如果在过量后不久进行脑脊液引流和交换，效果特别显著。在本文中，我们描述了一种治疗超过 100mg 的严重 IT-MTX 过量的治疗方案。治疗的主要方法是将过量的甲氨蝶呤从脑脊液中稀释和去除，并辅以特异性解毒治疗。
