Clinical and radiological findings in methadone-induced delayed leukoencephalopathy

Bilevičiūtė-Ljungar, Indrė; Häglund, Vera; Carlsson, Jan‐Otto; Heijne, Anders von

doi:10.2340/16501977-1820

Cited by 19 publications

(15 citation statements)

References 8 publications

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“…Methadone-induced brain toxic leukoencephalopathy is reported in several cases with decreased level of consciousness [Salgado et al, 2010; Cerase et al, 2011; Bileviciute-Ljungar et al, 2014]. In addition, there is a cerebellar and basal ganglia involvement in methadone overdose as well [Corre et al, 2013].…”

Section: Discussionmentioning

confidence: 99%

Methadone use in a male with the FMRI premutation and FXTAS

Muzar

Lozano

Schneider

et al. 2015

American J of Med Genetics Pt A

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The fragile X-associated tremor ataxia syndrome (FXTAS) is caused by the premutation in FMR1 gene. Recent reports of environmental toxins appear to worsen the progression of FXTAS. Here we present a case of male adult with FXTAS and a long history of methadone use. The patient shows a faster progression in both symptoms of disease and MRI changes compared to what is typically seen in FXTAS. There has been no research regarding the role of narcotics in onset, progression, and severity of FXTAS symptoms. However, research has shown that narcotics can have a negative impact on several neurodegenerative diseases, and we hypothesize that in this particular case, methadone may have contributed to a faster progression of FXTAS as well as exacerbating white matter disease through RNA toxicity seen in premutation carriers.

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Section: Discussionmentioning

confidence: 99%

Methadone use in a male with the FMRI premutation and FXTAS

Muzar

Lozano

Schneider

et al. 2015

American J of Med Genetics Pt A

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“…Furthermore, during examination of DWI and ADC, no restriction was found in either case. Four patients have been described with restriction in DWI scans, although a correlation with ADC was not reported in them [9,17,18,20]. It is possible that the restrictions observed in these patients is related to T2 shine through, as this phenomenon has also been observed in our patients.…”

Section: Discussionmentioning

confidence: 51%

“…To date, only 8 case reports evaluating 11 patients have been published reporting delayed-onset methadone-induced leukoencephalopathy [6,10,[16][17][18][19][20], summarized in Table 5. The most frequent imaging findings in case reports of patients with DOL is bilateral cerebral white matter T2 and FLAIR hyperintensity [6,8,9,16,18,20] followed by corpus callosum [9,16] and globus pallidus [8] involvement.…”

Section: Discussionmentioning

confidence: 99%

“…Other case studies have reported a range of DOL symptoms, including disorientation, paranoid and bizarre behavior, and severe progressive cognitive decline with bilateral cerebral white matter hyperintensities. MRI changes in these case reports have included diffuse abnormal T2 and FLAIR signals in the corona radiate, centrum semiovale and subcortical white matter throughout all lobes, and signal abnormalities in temporomesial, substantia nigra, and basal ganglia [6,8,9,12,13,[17][18][19][20][21]. The aim of our study was to identify and describe the pattern of neurological deficits and associated brain magnetic resonance imaging (MRI) changes in methadone-poisoned patients.…”

Section: Introductionmentioning

confidence: 99%

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Methadone-induced encephalopathy: a case series and literature review

et al. 2020

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Background: Accidental ingestion or consumption of supra-therapeutic doses of methadone can result in neurological sequelae in humans. We aimed to determine the neurological deficits of methadone-poisoned patients admitted to a referral poisoning hospital using brain magnetic resonance (MR) and diffusion weighted (DW) imaging. Methods: In this retrospective study, brain MRIs of the patients admitted to our referral center due to methadone intoxication were reviewed. Methadone intoxication was confirmed based on history, congruent clinical presentation, and confirmatory urine analysis. Each patient had an MRI with Echo planar T1, T2, FLAIR, and DWI and apparent deficient coefficient (ADC) sequences without contrast media. Abnormalities were recorded and categorized based on their anatomic location and sequence. Results: Ten patients with abnormal MRI findings were identified. Eight had acute-and two had delayed-onset encephalopathy. Imaging findings included bilateral confluent or patchy T2 and FLAIR high signal intensity in cerebral white matter, cerebellar involvement, and bilateral occipito-parietal cortex diffusion restriction in DWI. Internal capsule involvement was identified in two patients while abnormality in globus pallidus and head of caudate nuclei were reported in another. Bilateral cerebral symmetrical confluent white matter signal abnormality with sparing of subcortical U-fibers on T2 and FLAIR sequences were observed in both patients with delayed-onset encephalopathy. Conclusions: Acute-and delayed-onset encephalopathies are two rare adverse events detected in methadoneintoxicated patients. Brain MRI findings can be helpful in detection of methadone-induced encephalopathy.

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“…Es necesario tener en cuenta que, como sucede con el resto de opiáceos (Katz, 2005;Benyamin et al, 2008), la metadona no es un fármaco exento de efectos secundarios e indeseados (Bell y Zador, 2000;Bileviciute-Ljungar, Häglund, Carlsson y von Heijne, 2014;Chugh et al, 2008;Grönbladh y Öhlund, 2011;Webster, 2013), cuya probabilidad de aparición e intensidad se incrementan en paralelo a las dosis (Leavitt, 2003;Walker, Klein y Kasza, 2003), apareciendo con cierta frecuencia complicaciones de gran envergadura a dosis altas (Krantz, Kutinsky, Robertson y Mehler, 2003), aunque también a dosis no tan altas (Krantz, Martin, Stimmel, Mehta y Haigney, 2009;Roy et al, 2012). Entre estos efectos secundarios, los déficits en el rendimiento neuropsicológico están entre los más frecuentemente identificados (Bracken et al, 2012;Gruber et al, 2006;Loeber, Kniest, Diehl, Mann y Croissant, 2008;Mintzer, Copersino y Stitzer, 2005;Mintzer y Stitzer, 2002;Rass et al, 2014) y se incrementan en paralelo a las dosis (Rass et al, 2014).…”

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Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

Pérez

MethaQoL

2016

Adicciones

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The effectiveness of methadone maintenance treatment is beyond any doubt, but there remains some incertitude about the appropriate and effective dosage and the objectives that should be achieved by this therapy. Some authors maintain that only doses higher than 50-60 mg/day ought to be considered effective, since only these block all the opioid receptors. But others propose the use of doses adjusted to the needs of the patient, based on their recovery process. ADICCIONES, 2017 · VOL. 29 NÚM. 1 38 Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

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Clinical and radiological findings in methadone-induced delayed leukoencephalopathy

Abstract: Delayed leukoencephalopathy should be suspected in patients who deteriorate after methadone overdose. Drugs such as sertraline and baclofen may be of use in treating delayed leukoencephalopathy.

Cited by 19 publications

References 8 publications

Methadone use in a male with the FMRI premutation and FXTAS

Methadone use in a male with the FMRI premutation and FXTAS

Methadone-induced encephalopathy: a case series and literature review

Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

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