Razi Wajeeha, Haque Anwar Ul, Sadiq Hassaan, Ullah Raza, Jabbar Naeem, Mirza Sadiq
Department of Paediatrics, The Indus Hospital, Karachi, Pakistan.
Department of Paediatrics Critical Care Medicine, The Indus Hospital, Karachi, Pakistan.
J Coll Physicians Surg Pak. 2021 Apr;31(4):481-484. doi: 10.29271/jcpsp.2021.04.481.
Children with acute lymphoblastic leukemia, receiving intrathecal methotrexate (IT-MTX), develop acute and subacute neurological dysfunction in 3-15% of cases. Altered level of consciousness, seizure, and stroke-like manifestations are among the most common presentations. MRI of the brain in an early stage is consistent with white matter leukoencephalopathy. There are no specific guidelines for the treatment of such a syndrome. An elevated cerebrospinal fluid (csf) adenosine concentration causes vasodilatation in the brain and leads to cerebral ischemia, which may be reduced by aminophylline infusion. The study is a retrospective data analysis in which electronic data records of 30 patients, collected from September 2017 - August 2019. The primary objective of the study was to evaluate the safety and efficacy of aminophylline in IT-MTX induced neurotoxicity. Aminophylline infusion was used in 30 patients with IT-MTX neurotoxicity. Twenty-five patients (83.33%) showed dramatic improvement of neurologic signs and symptoms within 48 hours. Aminophylline was, hence, coined as a salvageable therapy. No noticeable side effects were observed during treatment with aminophylline infusion. Key Words: Intrathecal methotrexate, Neurotoxicity, Children, Cancer, Aminophylline.
接受鞘内注射甲氨蝶呤（IT-MTX）的急性淋巴细胞白血病患儿中，3%-15%会出现急性和亚急性神经功能障碍。意识水平改变、癫痫发作和类似中风的表现是最常见的症状。早期脑部MRI与白质脑病相符。对于这种综合征的治疗尚无具体指南。脑脊液（CSF）腺苷浓度升高会导致脑部血管扩张并引发脑缺血，氨茶碱输注可能会减轻这种情况。该研究是一项回顾性数据分析，收集了2017年9月至2019年8月期间30例患者的电子数据记录。该研究的主要目的是评估氨茶碱治疗IT-MTX诱导的神经毒性的安全性和有效性。30例IT-MTX神经毒性患者接受了氨茶碱输注。25例患者（83.33%）在48小时内神经体征和症状有显著改善。因此，氨茶碱被视为一种可挽救的治疗方法。氨茶碱输注治疗期间未观察到明显副作用。关键词：鞘内注射甲氨蝶呤、神经毒性、儿童、癌症、氨茶碱
