Reversible Parkinsonism after chronic cyclosporin treatment in renal transplantation

Abstract

VideoCyclosporin A (CsA)-induced neurotoxicities are common, reported in up to 40% of transplant patients receiving CsA.

Case report: Cyclosporine A-induced extrapyramidal syndrome following hematopoietic stem cell transplantation

“…The clinical symptoms of these patients can be devastating and can include severe functional impairment. These extreme clinical symptoms have been reported in 10 of 17 patients with mutism and reduced spontaneous movements lasting for at least a few days ( 3 , 4 , 8 , 9 , 11 ) ( Table 1 ). Seven out of 10 patients were reported to have normal written and oral comprehension as well as intact orientation ( 3 ).…”

“…Extrapyramidal manifestations are rare adverse events of cyclosporine A neurotoxicity, which includes a spectrum of symptoms ranging from akinetic mutism to tremors (1, 2). However, reported patients are scarce, and the symptomatology timing, neuroimaging findings, and recovery after the discontinuation of medication are not well understood (3)(4)(5)(6)(7)(8)(9)(10). A total of 17 patients are reported in the literature with cyclosporine neurotoxicity-induced EP signs, including our patient (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

“…However, reported patients are scarce, and the symptomatology timing, neuroimaging findings, and recovery after the discontinuation of medication are not well understood (3)(4)(5)(6)(7)(8)(9)(10). A total of 17 patients are reported in the literature with cyclosporine neurotoxicity-induced EP signs, including our patient (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The clinical symptoms of these patients can be devastating and can include severe functional impairment.…”

“…Seven out of 10 patients were reported to have normal written and oral comprehension as well as intact orientation (3). In contrast, three patients were reported to have some encephalopathy (one with agitation and odd mannerism followed by mutism, one with stuporous and bedridden 10 months after symptom onset of progressive dyskinesia, and one with reduced responsiveness and abnormal movements of the right arm) (8,9,11). Among the 10 patients with mutism, five started with speech difficulties/dysarthria and progressed to complete mutism with decreased spontaneous movements.…”

“…One patient had an oculogyric crisis (4). Six of the 17 patients were reported to have parkinsonism (7)(8)(9)(10)12). Parkinsonism symptoms vary from rest tremors to severe rigidity, dyskinesia, and unresponsiveness.…”