Talk:Toxic leukoencephalopathy

Re: antioxidant therapies for toxic leukoencephalopathy

"Coenzyme Q and vitamin supplements, typically vitamin C and vitamin E, and other antioxidant therapies have been suggested to treat heroin-induced leukoencephalopathy patients. However, such treatments have rarely been trialed.[1][13]"

There appears to be scant evidence that antioxidants improve clinical outcomes in toxic leukoencephalopathy. The first reference cited here refers to an article which vaguely states “Although the exact role of such anti-oxidant therapy in this condition is unclear, clinical benefit has been suggested in some reported cases,” itself citing this article, which discusses two case studies in which one patient who received antioxidants recovered over two years, and the other improved but developed a cerebellar hand tremor. “Both still have white matter abnormalities on MRI and MRS,” (including elevated lactate) the article states. The authors conclude from these two outcomes and lactate as seen by MRS that heroin-induced leukoencephalopathy is due to induced mitochondrial dysfunction (but see here the long list of causes of lactic acidosis). This can be corrected, they argue, because patients with known mitochondrial disorders also show elevated lactate in CSF. They conclude “Although the role, if any, of antioxidant therapy in this condition remains uncertain, it may be prudent to administer oral coenzyme Q supplemented with vitamins C and E to future patients, as this treatment was well tolerated and might have contributed to recovery in our patients.” Not exactly a ringing endorsement, which is good since they are basing these claims on the course of two patients.

It may be the case that antioxidants are useful in this context but the condition is so rare, has been studied so little, that we should be very careful about extrapolating too much from very limited data, especially when evidence of mechanism is so lacking. This is especially the case when discussing antioxidants, an oft-repeated word but a very complex topic. Perhaps we can rephrase or remove this line in the article here. I removed the reference to the second article because it never once mentions antioxidants, vitamin E, vitamin C, or Coenzyme Q. Inoculatedcities (talk) 13:54, 29 August 2014 (UTC)