Altered Mental Status from Acyclovir

Martínez-Díaz, Gabriel J.; Hsia, Renee Y.

doi:10.1016/j.jemermed.2009.08.048

Cited by 15 publications

(14 citation statements)

References 12 publications

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“…Reversible neuropsychiatric symptoms have been reported infrequently during treatment and are usually associated with pre-existing renal insufficiency (Smith et al, 2010 ). Patients with abnormal renal function require dose adjustments with these medications (Martinez-Diaz and Hsia, 2011 ). Twenty-nine multiple sclerosis patients treated with valacyclovir at a dose of 3 grams per day for 2 years had no discontinuation of the medication due to side effects in a clinical trial by Friedman et al ( 2005 ).…”

Section: Rationale For An Antiviral Ad Clinical Trialmentioning

confidence: 99%

Molecular Mechanisms for Herpes Simplex Virus Type 1 Pathogenesis in Alzheimer’s Disease

Harris

2018

Front. Aging Neurosci.

121

149

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This review focuses on research in the areas of epidemiology, neuropathology, molecular biology and genetics that implicates herpes simplex virus type 1 (HSV-1) as a causative agent in the pathogenesis of sporadic Alzheimer’s disease (AD). Molecular mechanisms whereby HSV-1 induces AD-related pathophysiology and pathology, including neuronal production and accumulation of amyloid beta (Aβ), hyperphosphorylation of tau proteins, dysregulation of calcium homeostasis, and impaired autophagy, are discussed. HSV-1 causes additional AD pathologies through mechanisms that promote neuroinflammation, oxidative stress, mitochondrial damage, synaptic dysfunction, and neuronal apoptosis. The AD susceptibility genes apolipoprotein E (APOE), phosphatidylinositol binding clathrin assembly protein (PICALM), complement receptor 1 (CR1) and clusterin (CLU) are involved in the HSV lifecycle. Polymorphisms in these genes may affect brain susceptibility to HSV-1 infection. APOE, for example, influences susceptibility to certain viral infections, HSV-1 viral load in the brain, and the innate immune response. The AD susceptibility gene cholesterol 25-hydroxylase (CH25H) is upregulated in the AD brain and is involved in the antiviral immune response. HSV-1 interacts with additional genes to affect cognition-related pathways and key enzymes involved in Aβ production, Aβ clearance, and hyperphosphorylation of tau proteins. Aβ itself functions as an antimicrobial peptide (AMP) against various pathogens including HSV-1. Evidence is presented supporting the hypothesis that Aβ is produced as an AMP in response to HSV-1 and other brain infections, leading to Aβ deposition and plaque formation in AD. Epidemiologic studies associating HSV-1 infection with AD and cognitive impairment are discussed. Studies are reviewed supporting subclinical chronic reactivation of latent HSV-1 in the brain as significant in the pathogenesis of AD. Finally, the rationale for and importance of clinical trials treating HSV-1-infected MCI and AD patients with antiviral medication is discussed.

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Section: Rationale For An Antiviral Ad Clinical Trialmentioning

confidence: 99%

Molecular Mechanisms for Herpes Simplex Virus Type 1 Pathogenesis in Alzheimer’s Disease

Harris

2018

Front. Aging Neurosci.

121

149

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“…Some drugs with an elevated risk for seizures are isoniazid, bupropion and venlafaxine [35]. Table 2 lists the most representative drugs [19,[35][36][37][38][39][40].…”

Section: Medicationsmentioning

confidence: 99%

“…About the etiology of unprovoked seizures, the most recent ILAE´s classification suggests the following categories: genetic, structural, infectious, metabolic, immune and unknown ( Table 3) [41]. [43,44] 65 years: cerebrovascular diseases are the main etiology (overall 50%) followed by traumatic brain injury and brain tumors [38,45].…”

Section: Othersmentioning

confidence: 99%

A Clinical Review of First Seizures in Adult Patients

Mayo¹

2019

Med Clin Rev

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First seizures in adult patients are a common problem in clinical practice, and their management represents a challenge for physicians. The aim of this review is to develop a systematic clinical approach for the classification, diagnosis, and treatment of patients who have experienced a first seizure. This could help clinicians to recognize and treat this condition appropriately. Because these seizures can arise from several etiologies, it is essential to know if the event was a provoked (acute symptomatic) or unprovoked seizure. Thus, an adequate classification is important to establish the length of the diagnosis approach, the necessary treatment, and every individual prognosis. We found that patients diagnosed with a single unprovoked seizure require electroencephalography and magnetic resonance imaging. This will allow an assessment of the risk of recurrence and the identification of patients that follow the diagnosis criteria for epilepsy. We recommend individualized pharmacological therapy to reduce early seizure recurrence (≤2 years) even if it can produce some adverse effects. Finally, we determine that there are still certain areas of uncertainty to promote future research in this topic.

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“…ACV is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase to its main metabolite CMMG. [10][11][12][13] The diagnosis of AINSs has in many cases been delayed due to the similarity between symptoms emanating from the suspected viral disease the clinicians are treating and adverse drug reactions from ACV. We have not been able to detect 8-OH-ACV in our patient samples.…”

Section: Therapeutic Drug Monitoring Consultantmentioning

confidence: 99%

Differential Diagnosis of Central Nervous System Involvement in a Patient Treated With Acyclovir

Euler

Axelsson²,

Helldén³

2013

Therapeutic Drug Monitoring

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Acyclovir-induced neuropsychiatric symptoms (AINSs) may resemble several diseases of the central nervous system. Laboratory testing of acyclovir may be critical in supporting the diagnosis of AINSs when there is doubt. We present a case of suspected herpes encephalitis in which the diagnosis of AINSs was supported by therapeutic drug monitoring of plasma and cerebrospinal fluid concentrations of acyclovir and its main metabolite 9-carboxymethoxymethylguanine.

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Altered Mental Status from Acyclovir

Cited by 15 publications

References 12 publications

Molecular Mechanisms for Herpes Simplex Virus Type 1 Pathogenesis in Alzheimer’s Disease

Molecular Mechanisms for Herpes Simplex Virus Type 1 Pathogenesis in Alzheimer’s Disease

A Clinical Review of First Seizures in Adult Patients

Differential Diagnosis of Central Nervous System Involvement in a Patient Treated With Acyclovir

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