What are the proposed mechanisms for methotrexate mediated neurotoxicity?
Chronic folate depletion; homocysteine excess through folate dependent methylation and alterations of biopterin and adenosine metabolism resulting in decreased neurotransmitter synthesis.
1. Subrahmanian KN et al. Evaluation and Management of Acute Onset Hemiparesis in an Adolescent with Leukemia. Pediatr Emerg Care 2018; 34: 347-e50.
2. Drachtman RA et al. Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity. Pediatric Hematology and Oncology 2002; 19(5): 319-327.