Aluminum encephalopathy syndrome is a progressive encephalopathy of infants and children with chronic renal insufficiency who have taken aluminum-containing products such as phosphate binders for several years.3,16-18 Adults occasionally are also affected. Patients have elevated brain aluminum concentration.17,19 Aluminum absorption is increased in renal insufficiency by secondary hypoparathyroidism, and aluminum excretion is reduced.3 The aluminum is stored in bones and other tissues.17
Aluminum encephalopathy occasionally is seen in patients with normal renal function receiving large amounts of aluminum, such as aluminum bladder irrigation.20,21 There is speculation that aluminum intoxication may play a role in Alzheimer’s disease, based upon morphologic and immunologic similarities of the two conditions.22
The clinical features of aluminum encephalopathy are:3
Imaging studies show cortical atrophy.
The diagnosis of aluminum encephalopathy syndrome is suggested by the presence of typical symptoms in a child with chronic renal disease who has been taking aluminum-containing products.3 The diagnosis is confirmed by elevated plasma and bone aluminum concentrations and by typical EEG and imaging findings.3
Benzodiazepines such as clonazepam and diazepam are effective in controlling myoclonus.
Phenytoin usually is used to control the tonic-clonic or partial seizures. Relatively little phenytoin is removed by hemodialysis, and intravenous loading doses can be given to maintain a desired plasma concentration after the procedure. (See Correction for drug loss during hemodialysis)
Adapted from: Browne TR. Renal disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;49-62. With permission from Elsevier (www.elsevier.com).
Reviewed and revised February 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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