LOSS OF SPEECH AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Alteration of speech is a rare but distressing complication of orthoto pic liver transplantation (OLT). We describe a characteristic speech d isorder identified in a large series of consecutive patients undergoin g OLT. Between 1988 and 1993, 525 adults underwent OLT. For all recipi ents with neurologic complications, we reviewed clinical findings, ima ging and electrophysiologcal test results, and perioperative laborator y data. Five patients (ages 23-52: UNOS status 3-4) exhibited a charac teristic pattern of stuttering dysarthria, leading to complete loss of speech production, occasionally with elements of aphasia. In four of the five patients, right-sided focal seizures were subsequently noted. All cases presented within the first 10 postoperative days and improv ed within 1 month of cessation of cyclosporin (CyA), although halting, monotonous speech was evident to some degree in all five for up to 1 year, There was no correlation between onset of symptoms and CyA level s, None of the patients had clinical or radiologic findings suggestive of central pontine myelinolysis or akinetic mutism. EEGs and Spect sc an results were consistent with dysfunction in the left frontotompsrop arietal regions of the brain, A characteristic speech disorder, which may be described as cortical dysarthria or speech apraxia, occurs in a pproximately 1% of adults undergoing OLT. Prompt recognition of this s yndrome and temporary cessation of CVA therapy may favorably affect th e course.