title: Severe neurotoxicity following intrathecal methotrexate with nitrous oxide sedation in a child with acute lymphoblastic leukemia.
abstract: Systemic and intrathecal methotrexate is widely used in treatment protocols for childhood acute lymphoblastic leukemia. Its side effects vary in characteristics, intensity and time of onset, and depend on the administration route. Interactions with several drugs are known. Side effects of nitrous oxide sedation, often used for moderately painful procedures, typically occur after long time use and include neurological symptoms. We present a child who experienced a severe and long-lasting neurotoxicity after the third intrathecal application of methotrexate with short sedation by nitrous oxide during induction therapy for acute lymphoblastic leukemia. Symptoms completely resolved after 12 months.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Löbel
authors.forename: J
authors.initials: J
authors.lastname: Trah
authors.forename: G
authors.initials: G
authors.lastname: Escherich
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007278:Injections, Spinal; D020300:Intracranial Hemorrhages / Q000134:cerebrospinal fluid / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D020258:Neurotoxicity Syndromes / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000628:therapy; D009609:Nitrous Oxide / Q000008:administration & dosage / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography
chemical_list: D018712:Analgesics, Non-Narcotic; D007166:Immunosuppressive Agents; D009609:Nitrous Oxide; D008727:Methotrexate
keywords: leukemia; methotrexate; neurotoxicity; nitrous oxide