Methylphenidate treatment of neuropsychiatric symptoms of central and extrapontine myelinolysis

Objective: Previous reports describe the presentation and course of the neu robehavioral manifestations cf central and extrapontine myelinolysis; as of yet, however, there are no specific recommendations far treatment of these problems. We offer the first report of successful treatment. Method: We de scribe a 55-year-old man with chronic alcoholism who developed central and extrapontine myelinolysis following an episode of heavy drinking and rapid correction of hyponatremia The patient acutely developed motor, cognitive, emotional and behavioral problems best accounted for by central pontine and bilateral striatal myelinolysis. These neuropsychiatric symptoms were trea ted with methylphenidate over the course of I month in an off-on-off-on fas hion. The Neuropsychiatric Inventory and other tests were used to assess tr eatment response. Results: Marked improvements in the patient's neuropsychi atric status were noted only during treatment with methylphenidate. Conclus ions: Methylphenidate effectively reversed the neuropsychiatric symptoms as sociated with the patient's demyelinating lesions. We discuss possible unde rlying mechanisms of both symptom formation and treatment effect.