title: [Neuromyeloencephalopathy caused by high-dose muzolimine medication in patients with renal failure].
abstract: We report on 7 patients suffering from chronic renal failure (2 females, 5 males; aged 35-75 (phi 53.5) years) who showed severe neuromyeloencephalopathy (NME) after high doses of a new Henle's loop diuretic, Muzolimine. The temporal and phenomenological development of these systems was strikingly parallel. The neurological deficit was revealed on neurophysiological, neuroradiological and in 2 cases on neuropathological tests (gross demyelinisation of the posterior column, mainly of the fasciculus gracilis, less in the lateral corticospinal tract and in some spinal roots). The critical drug dose for first neurological impairment was 52 g on average; at this point the patients had been treated for 78 days. The maximal daily dose was 1.440 mg. Dominant clinical features were pallhypaesthesia, ataxia, signs of peripheral neuropathy in combination with hyperreflexia and progressive para- to tetraspastic paresis. Constellation of symptoms, course of disease and findings of additional investigations, especially those of neuropathology, very much resemble Vitamin B12 deficiency and SMON-(Subacute Myelo Optic Neuropathy) syndrome. The rare entity of Muzolimine-NME is discussed in respect to other endogenous and exotoxic neuromyelopathies. We present the hypothesis of a toxic, partially dialysable metabolite of Muzolimine.
authors.affiliation: Neurologische Klinik, Klinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg.
authors.forename: B
authors.initials: B
authors.lastname: Pohlmann-Eden
authors.forename: P
authors.initials: P
authors.lastname: Berlit
authors.forename: A
authors.initials: A
authors.lastname: Holle
authors.forename: H
authors.initials: H
authors.lastname: Kaschel
authors.forename: N
authors.initials: N
authors.lastname: Gretz
mesh_terms: D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000139:chemically induced*; D003711:Demyelinating Diseases / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects; D004576:Electromyography / Q000187:drug effects; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009156:Muzolimine / Q000008:administration & dosage / Q000009:adverse effects*; D009434:Neural Pathways / Q000187:drug effects; D009468:Neuromuscular Diseases / Q000139:chemically induced; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D011720:Pyrazoles / Q000009:adverse effects*; D013126:Spinal Nerve Roots / Q000187:drug effects; D009435:Synaptic Transmission / Q000187:drug effects
chemical_list: D011720:Pyrazoles; D009156:Muzolimine
vernacular_title: Neuromyeloenzephalopathie (NME) unter hochdosierter Muzolimin-Medikation bei niereninsuffizienten Patienten.