EEG with extreme delta brush in young female with methotrexate neurotoxicity supports NMDA receptor involvement

Eur J Paediatr Neurol. 2017 Sep;21(5):795-797. doi: 10.1016/j.ejpn.2017.05.008. Epub 2017 Jun 15.

Abstract

Sub-acute neurotoxicity is a well-known complication to high-dose and intrathecal methotrexate (MTX) treatment of children with leukemia. Symptoms can be treated safely by dextromethorphan, a non-competitive antagonist to N-methyl-D-aspartic acid receptor (NMDAR). In a female with subacute MTX neurotoxicity, we observed an electroencephalographic (EEG) with extreme delta brush. Extreme delta brush is an EEG pattern previously described in patients with NMDAR autoimmune encephalitis. The observations suggest that the mechanism of this neurotoxicity may be mediated by the NMDAR. Furthermore, extreme EEG delta brush should suggest a diagnosis of MTX associated subacute neurotoxicity.

Keywords: ALL; EEG; Extreme delta brush; Methotrexate; NMDA receptor; Neurotoxicity.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / chemically induced*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Antimetabolites, Antineoplastic / adverse effects*
  • Dextromethorphan / therapeutic use
  • Electroencephalography
  • Female
  • Humans
  • Methotrexate / adverse effects*
  • Receptors, N-Methyl-D-Aspartate / antagonists & inhibitors

Substances

  • Antimetabolites, Antineoplastic
  • Receptors, N-Methyl-D-Aspartate
  • Dextromethorphan
  • Methotrexate