title: Muzolimine-induced severe neuromyeloencephalopathy: report of seven cases.
abstract: We report on 7 patients (2 women, 5 men) with chronic renal failure, who developed under a high dosage of the new diuretic muzolimine (range 240 to 1440 mg per day) fatal neuromyeloencephalopathy. Clinical neurophysiological and neuroradiological findings and finally neuropathological studies in 2 patients resembled those found in vitamin-B12-deficiency-syndrome with a predominant affection of the spinal posterior column and the corticospinal tracts. The first neurological symptoms like paraesthesia, severe hyperpathia of the legs and mild to heavy spinal ataxia occurred after an average time of treatment of 78 days and a mean dosage of 52 g. The most progressive neurological deficits like severe tetraspastic paresis, were seen only in the nondialytic renal insufficient group (3 patients), while the others had a more benign course of the disease. This lead to the hypothesis of a partially dialysable toxic metabolite of muzolimine. After a follow-up of more than 2 1/2 years no significant recovery was seen in these cases.
authors.affiliation: Department of Neurology, University of Heidelberg, Mannheim Hospital, West Germany.
authors.forename: B
authors.initials: B
authors.lastname: Pohlmann-Eden
authors.forename: P
authors.initials: P
authors.lastname: Berlit
authors.forename: E A
authors.initials: EA
authors.lastname: Maibach
authors.forename: N
authors.initials: N
authors.lastname: Gretz
mesh_terms: D000328:Adult; D000368:Aged; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000139:chemically induced* / Q000473:pathology; D009156:Muzolimine / Q000008:administration & dosage / Q000009:adverse effects*; D010525:Peripheral Nerves / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000473:pathology; D011712:Pyramidal Tracts / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D009156:Muzolimine