Síndrome cerebeloso por amiodarona

Abstract

I. RAVERA, ROBERTOEP. SICA RESUMEN -La amiodarona (AMD) es una droga antiarrítmica cuyos efectos adversos pueden comprometer el sistema nervioso central y periférico. La aparición de un síndrome cerebeloso es infrecuente. Se presenta un paciente masculino de 56 anos de edad que desarolla un síndrome pancerebeloso de 4 meses de evolución, que revierte luego de la suspension de la AMD. El cuadro reaparece meses mas tarde luego de un período de automedicacion con la droga. Los mecanismos tóxicos por los cuales la AMD afecta al cerebelo permanecen inciertos. Esta droga de amplia difusión en nuestro medio, como otros antiarrítmicos, posee efectos sobre el sistema nervioso que deben ser tenidos en cuenta a fin de poder detectarlos precozmente.PALABRAS-LLAVE: síndrome cerebeloso, amiodarona.Cerebellar syndrome by amiodarone SUMMARY -Amidarone (AMD) is an antiarrhytmic drug with side effects on the nervous system. Cerebellum is seldom involved. We describe the case of a 56 years old male patient with a history of 4 month of cerebellar involvement characterized by gait unstadiness, ataxia, nistagmus and vertigo. He was on treatment with AMD because of ventricular arrythmia. The cerebellar syndrom progressively disappeared after drug whitdrawal and he was symptoms-free 4 months later. Similar symptoms appeared after another one month of automedication with the same drug. Structural lesions, metabolic, nutritional deficiencies or toxics were excluded. Mechanisms of cerebellar toxicity of AMD are yet unknown. The knowledge of the toxic effects of this drug, widely used in our country, would allow its early recognition.KEY WORDS: cerebellar syndrome, amiodarone.La amiodarona (AMD) es una droga de uso frecuente en nuestro medio para el tratamiento de arritmias ventriculares y supraventriculares 10 . Sus efectos adversos sistemicos mas comunes son: hipertiroidismo, hipotiroidismo, depósitos corneales, fibrosis pulmonar, fotosensibilidad y aumento de las enzimas hepáticas 1,4 . Según las diferentes series, entre 20 y 54% de los pacientes que reciben AMD pueden presentar efectos colaterales sobre el sistema nervioso central y periférico 1,4 . El mas frecuente de ellos es la aparición de temblor postural, menos frecuentemente se describen trastornos en la marcha, parkinsonismo, distaxia de miembros, neuropatía y nistagmus 1,3 . Presentamos un paciente de 56 anos de edad, que desarrollo un síndrome pancerebeloso en relación a la administración de AMD, que remitió luego de la suspensión del fármaco. CASOFG, paciente de 56 anos de edad, de sexo masculino que, a raíz de una arritmia ventricular, inicia tratamiento con AMD, en dosis de 600 mg/dia. Tres meses mas tarde comienza con vértigo e inestabilidad progresiva para

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“…Amiodarone has many well-known toxicities, including thyroid toxicity, pulmonary fibrosis, dermatological side effects, corneal deposits, and hepatotoxicity [62,63]. Amiodarone can also be neurotoxic in 20-54% of patients and can cause a postural tremor, parkinsonism, peripheral neuropathy and cerebellar deficits [23,62,64]. Cerebellar deficits can include truncal or limb ataxia, wide-based gait, axial hypotonia, nystagmus, vertigo, dysdiadochokinesia, dysmetria, dysarthria, and dysphagia [62][63][64].…”

“…Amiodarone can also be neurotoxic in 20-54% of patients and can cause a postural tremor, parkinsonism, peripheral neuropathy and cerebellar deficits [23,62,64]. Cerebellar deficits can include truncal or limb ataxia, wide-based gait, axial hypotonia, nystagmus, vertigo, dysdiadochokinesia, dysmetria, dysarthria, and dysphagia [62][63][64]. Neurological workup including head CT, brain MRI, and EMG may be unrevealing 63,64.…”

“…Neurological workup including head CT, brain MRI, and EMG may be unrevealing 63,64. Approximately 5-7% of patients treated with amiodarone develop cerebellar toxicity [10,23,64]. In one study of 54 patients treated with amiodarone for ventricular arrhythmias, 54% had neurotoxicity [65].…”

“…In one study of 54 patients treated with amiodarone for ventricular arrhythmias, 54% had neurotoxicity [65]. Among those who develop cerebellar toxicity, 52% will develop cerebellar symptoms within one month of therapy initiation, and in another 26% symptoms develop in 1-4 months [64][65].…”

“…Symptoms may improve with discontinuation of amiodarone over months to years, while in some cases residual symptoms do not resolve [62,64,65]. In one case report, symptoms improved with reduction amiodarone dosing by 50%, and resolved once the medication was stopped.…”