Q: 32 year old female is admitted to ICU with seizures after Methotrexate (MTX) treatment. Can MTX can be prescribed to her again in the future? (select one)
A) Yes
B) No
Answer: A
Neurotoxicity due to MTX is common. It can be acute within the first 24 hours, subacute within a week or can be chronic for months and years. It may manifest as somnolence, confusion, or seizures. Fortunately, it resolves without sequelae with reversal of changes on MRI. MTX can be given as oral, intravenous (IV), intramuscular (IM) or intrathecal (IT).
#pharmacology
#neurology
References:
1. Bhojwani D, Sabin ND, Pei D, et al. Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol. 2014;32(9):949-959. doi:10.1200/JCO.2013.53.0808
2. Brugnoletti F, Morris EB, Laningham FH, et al. Recurrent intrathecal methotrexate induced neurotoxicity in an adolescent with acute lymphoblastic leukemia: Serial clinical and radiologic findings. Pediatr Blood Cancer. 2009;52(2):293-295. doi:10.1002/pbc.21764
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