title: Loss of speech after orthotopic liver transplantation.
abstract: Alteration of speech is a rare but distressing complication of orthotopic liver transplantation (OLT). We describe a characteristic speech disorder identified in a large series of consecutive patients undergoing OLT. Between 1988 and 1993, 525 adults underwent OLT. For all recipients with neurologic complications, we reviewed clinical findings, imaging and electrophysiologic test results, and perioperative laboratory data. Five patients (ages 23-52; UNOS status 3-4) exhibited a characteristic pattern of stuttering dysarthria, leading to complete loss of speech production, occasionally with elements of aphasia. In four of the five patients, right-sided focal seizures were subsequently noted. All cases presented within the first 10 postoperative days and improved with 1 month of cessation of cyclosporin (CyA), although halting, monotonous speech was evident to some degree in all five for up to 1 year. There was no correlation between onset of symptoms and CyA levels. None of the patients has clinical or radiologic findings suggestive of central pontine myelinolysis or akinetic mutism. EEGs and Spect scan results were consistent with dysfunction in the left frontotemporoparietal regions of the brain. A characteristic speech disorder, which may be described as cortical dysarthria or speech apraxia, occurs in approximately 1% of adults undergoing OLT. Prompt recognition of this syndrome and temporary cessation of CyA therapy may favorable affect the course.
authors.affiliation: Division of Liver Transplantation, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Bronster
authors.forename: P
authors.initials: P
authors.lastname: Boccagni
authors.forename: M
authors.initials: M
authors.lastname: O'Rourke
authors.forename: S
authors.initials: S
authors.lastname: Emre
authors.forename: M
authors.initials: M
authors.lastname: Schwartz
authors.forename: C
authors.initials: C
authors.lastname: Miller
mesh_terms: D000328:Adult; D001037:Aphasia / Q000188:drug therapy / Q000209:etiology*; D016572:Cyclosporine / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012640:Seizures / Q000209:etiology
chemical_list: D016572:Cyclosporine