The neuropathological effects resulting from the intrathecal injection of chemical substances

Wolman, Lionel

doi:10.1038/sc.1966.9

Cited by 27 publications

(13 citation statements)

References 80 publications

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“…Fluorescein has also been used. Most ofthese dyes can, however, cause significant morbidity (Wolman, 1966). Tomography, pneumoencephalography, and subdural pneumography frequently provide help for the localization ofthe leaking break.…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic cerebrospinal fluid rhinorrhoea.

Ommaya¹,

Chiro²,

Baldwin³

et al. 1968

Journal of Neurology, Neurosurgery & Psychiatry

326

158

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Section: Discussionmentioning

confidence: 99%

Non-traumatic cerebrospinal fluid rhinorrhoea.

Ommaya¹,

Chiro²,

Baldwin³

et al. 1968

Journal of Neurology, Neurosurgery & Psychiatry

326

158

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“…[29][30][31][32][33][34][35][36] Reported complications from these routes of administration include nausea, stupor, headache, weakness or numbness in the arms or legs, pain, facial paresis, optic neuropathy, spinal cord necrosis, and even death. [29][30][31][32][33][34][35][36] The fact that methylene blue can be neurotoxic in humans complicates the interpretation of the pivotal mitoxantrone trial results, especially in circumstances where 17 to 22% of placebo patients had openings in their bloodbrain barrier (BBB) at the time of each methylene blue administration. 11 The short-term side effects observed in the two pivotal trials of mitoxantrone were generally mild but common complaints (in more than 25 to 30% of treated patients) included nausea, menstrual disturbances, alopecia, upper respiratory infections, and urinary tract infections.…”

mentioning

confidence: 99%

The use of mitoxantrone (Novantrone) for the treatment of multiple sclerosis [RETIRED]

et al. 2003

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Abstract-Mitoxantrone is the first drug approved for the treatment of secondary progressive multiple sclerosis (SPMS) in the United States. This assessment considers use of mitoxantrone in the treatment of MS. Mitoxantrone probably reduces the clinical attack rate and reduces attack-related MRI outcomes in patients with relapsing MS (Type B recommendation). Also, mitoxantrone may have a beneficial effect on disease progression in patients with MS whose clinical condition is worsening (Type B recommendation). The potential for serious toxicity of mitoxantrone, however, must be taken into account when considering this therapy in individual patients. Moreover, because the potential clinical benefits on disease progression appear to be only modest, the results of the single phase III trial should be replicated in another (and hopefully much larger) clinical study before this agent is widely recommended for the treatment of patients with MS. NEUROLOGY 2003;61:1332-1338 Mitoxantrone hydrochloride (Novantrone) is an anthracenedione that has been used as an antineoplastic agent to treat hormone-refractory prostate cancer and acute nonlymphocytic leukemia in adults. It exerts its antineoplastic action by intercalating into DNA and producing both DNA strand-breaks and interstrand cross-links; it also interferes with RNA synthesis and markedly inhibits the enzyme topoisomerase II, which aids in the DNA repair process. [1][2][3][4] In the treatment of MS, mitoxantrone represents the latest in a long line of general immunosuppressive agents studied in this disease. Previously, most such agents have not shown clear-cut benefits in this condition. [5][6][7][8][9][10] On the basis of a phase III clinical trial in Europe, 11,12 and an earlier phase II study, 13 mitoxantrone recently received an expanded indication from the Food and Drug Administration (FDA) for use in secondary progressive MS (SPMS), in progressiverelapsing MS, and for patients with worsening relapsing-remitting (RR) MS. This last category is defined as patients whose neurologic status remains significantly abnormal between MS attacks.Mitoxantrone is the first drug approved for these indications in the United States, and it is the purpose of this assessment to consider both the evidence leading to the recent FDA approval as well as the appropriate clinical role of this agent in the management of patients with MS.Description of the analytic process. Articles for this review were searched in Medline under the keywords mitoxantrone and MS. Forty-one articles were identified by this search. The abstracts of these articles were reviewed and the original articles were selected for inclusion in the analysis only if they were either controlled trials or case series using mitoxantrone in the treatment of MS. Five such articles were identified, in addition to the phase III trial. 11,12 In addition, the reference lists of the articles found in this manner were also reviewed to identify articles or abstracts not found by the computer search.Analysis of the evidence. Followi...

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“…A similar toxic reaction has been described after intrathecal alcohol (Wolman, 1966). Jensen et al (1962) claimed that mixing cerebrospinal fluid with methylene blue before injection would neutralise the action of the dye but Schultz and Schwarz (1970) found that damage still occurred with this mixture.…”

Section: Discussionmentioning

confidence: 67%

Spinal cord necrosis after intrathecal injection of methylene blue.

Sharr¹,

Weller²,

Brice³

1978

Journal of Neurology, Neurosurgery & Psychiatry

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SUM M AR Y A 59 year old man had 6 ml of unbuffered methylene blue injected into the lumbar theca in an attempt to localise the source of cerebrospinal fluid rhinorrhoea. After injection of the dye he became shocked, and within the next few days he developed a mild paraparesis which subsequently progressed to a total paraplegia. The distribution of the spinal cord damage found at necropsy, eight and a half years after injection of the dye, is described and its relationship to the clinical picture discussed. Walker (1949) was the first to report the adverse clinical effects of methylene blue upon the central nervous system. This was followed by accounts of the toxic effects of intrathecal injection of the dye by Brihaye and Lorthoir (1957), Arieff and Pyzik (1960), Evans and Keegan (1960), Jensen et al. (1962), Schultz andSchwarz (1970), andGross (1974). The pathological changes in the spinal cord were described by Wolman (1966)

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The neuropathological effects resulting from the intrathecal injection of chemical substances

Cited by 27 publications

References 80 publications

Non-traumatic cerebrospinal fluid rhinorrhoea.

Non-traumatic cerebrospinal fluid rhinorrhoea.

The use of mitoxantrone (Novantrone) for the treatment of multiple sclerosis [RETIRED]

Spinal cord necrosis after intrathecal injection of methylene blue.

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