Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments.

Autor: Repple J; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.; Department of Psychiatry, University of Münster, Münster, Germany., Haessner S; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany. svea.haessner@ukmuenster.de., Johnen A; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany., Landmeyer NC; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany., Schulte-Mecklenbeck A; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany., Pawlitzki M; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany., Wiendl H; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany., Meyer Zu Hörste G; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
Jazyk: angličtina
Zdroj: BMC neurology [BMC Neurol] 2021 Feb 22; Vol. 21 (1), pp. 85. Date of Electronic Publication: 2021 Feb 22.
DOI: 10.1186/s12883-021-02108-9
Abstrakt: Background: The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone-use and -abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare.
Case Presentation: Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid.
Conclusion: This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone.
Databáze: MEDLINE
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