Efficacy of Dextromethorphan and Cyclosporine A for Acute Encephalopathy

Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan. Electronic address: .
Pediatric Neurology (Impact Factor: 1.7). 03/2013; 48(3):200-5. DOI: 10.1016/j.pediatrneurol.2012.11.003
Source: PubMed


Acute encephalopathy with biphasic seizures and late reduced diffusion was recently established clinicoradiologically as an encephalopathy syndrome. The outcome of this encephalopathy is characterized by a low mortality rate and high incidence of neurologic sequelae. Although the exact pathogenesis of this encephalopathy is uncertain, excitotoxic injury with delayed neuronal death is proposed. On the basis of this hypothesis, we tried a combination therapy of N-methyl-D-aspartate receptor antagonist, dextromethorphan, and apoptosis inhibitor, cyclosporine A, in four patients with acute encephalopathy with biphasic seizures and late reduced diffusion. All patients recovered except for hyperactivity in one patient. Furthermore, an additional four patients with near-miss encephalopathy, who showed mild disturbance of consciousness at 24 hours after prolonged febrile seizures associated with exanthem subitum, recovered without secondary seizures by the early administration of dextromethorphan. The combination regimen of dextromethorphan and cyclosporine A could be effective for the treatment and prevention of acute encephalopathy with biphasic seizures and late reduced diffusion.

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Available from: Muneaki Matsuo
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    ABSTRACT: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common syndrome among acute encephalopathies, and is associated with a high incidence of neurologic sequelae. This study examined the efficacy of cyclosporine (CsA) for the treatment of AESD. Fourteen children with AESD were recruited and categorized as Group A (not receiving CsA) and Group B (receiving CsA). Their clinical courses, laboratory data, magnetic resonance imaging (MRI) scans, and outcomes were analyzed retrospectively. We divided the patients into 3 types according to the distribution of abnormalities on MRI scans: frontal lobe predominant type, unilateral cerebral hemisphere type, and diffuse type. We used the Pediatric Cerebral Performance Category scale (PCPC) and the Pediatric Overall Performance Category scale (POPC) as prognostic measures. Of the 14 children, 5 were boys (age range, 9-32 months). PCPC scores were: 1 for 7 patients, 2 for 3 patients, and 3 for 4 patients. There was no significant difference in PCPC between Groups A and B (p = 0.293). POPC scores were: 1 for 6 patients, 2 for 5 patients, and 3 for 3 patients. There was a significant difference in POPC between Groups A and B when patients with frontal lobe predominant type were excluded (p = 0.020). CsA could improve the neurological prognosis of patients with AESD, except for those with frontal lobe predominant type.
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