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Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature.
Palliat Support Care. 2015 Oct; 13(5):1241-9.PS

Abstract

OBJECTIVE

Thiamine-related encephalopathy (Wernicke's encephalopathy) is a neuropsychiatric syndrome caused by a vitamin B1 (thiamine) deficiency often associated with alcoholism. Cancer predisposes patients to thiamine deficiency unrelated to alcoholism, though many cases are missed clinically. The present report adds to the literature on thiamine as a palliative tool for thiamine-related encephalopathy (TRE) in cancer.

METHOD

From a larger series of TRE in cancer, we report on three cases with terminal illness.

RESULTS

Case 1. A 61-year old woman with Hodgkin's lymphoma developed TRE over 13 days. Precipitants included a hypermetabolic state in the background of subacute thiamine deficiency. Diagnosis was supported by abnormal serum thiamine and positive MRI findings. Mental status improved within 36 hours of initiating thiamine 500 mg IV t.i.d. Case 2. A 68-year-old man with colon cancer metastatic to liver and bone developed TRE precipitated by C. difficile-related diarrhea superimposed on 3 months of low appetite and weight loss. Diagnosis was supported by abnormal serum thiamine, and thiamine 500 mg IV t.i.d. was initiated. Improvements in mental status began within 36 hours. Case 3. An 80-year-old man with squamous cell carcinoma developed TRE precipitated by systemic infection in the context of three weeks of dysphagia. Antibiotic treatment did not reverse his cognitive symptoms, and a diagnosis of TRE was made based on operationalized criteria. Thiamine 100 mg IV daily did not reverse his symptoms. On his 30th day of admission, thiamine was increased to 500 mg IV t.i.d., resulting in a rapid reversal of altered mental status.

SIGNIFICANCE OF RESULTS

This report adds to the list of cancer types in which TRE/Wernicke's encephalopathy has been reported. It supports the use of higher doses of thiamine than are typically recommended in North America. Improvement following treatment allowed patients to engage with family and treatment teams prior to death.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.VA San Diego Healthcare System,San Diego,California.Department of Radiology,Memorial Sloan Kettering Cancer Center,New York,New York.Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

25339378

Citation

Isenberg-Grzeda, Elie, et al. "Palliative Treatment of Thiamine-related Encephalopathy (Wernicke's Encephalopathy) in Cancer: a Case Series and Review of the Literature." Palliative & Supportive Care, vol. 13, no. 5, 2015, pp. 1241-9.
Isenberg-Grzeda E, Hsu AJ, Hatzoglou V, et al. Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliat Support Care. 2015;13(5):1241-9.
Isenberg-Grzeda, E., Hsu, A. J., Hatzoglou, V., Nelso, C., & Breitbart, W. (2015). Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative & Supportive Care, 13(5), 1241-9. https://doi.org/10.1017/S1478951514001163
Isenberg-Grzeda E, et al. Palliative Treatment of Thiamine-related Encephalopathy (Wernicke's Encephalopathy) in Cancer: a Case Series and Review of the Literature. Palliat Support Care. 2015;13(5):1241-9. PubMed PMID: 25339378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. AU - Isenberg-Grzeda,Elie, AU - Hsu,Alan John, AU - Hatzoglou,Vaios, AU - Nelso,Christian, AU - Breitbart,William, Y1 - 2014/10/23/ PY - 2014/10/24/entrez PY - 2014/10/24/pubmed PY - 2016/7/12/medline KW - Cancer KW - Delirium KW - Thiamine KW - Thiamine-related encephalopathy KW - Wernicke's encephalopathy SP - 1241 EP - 9 JF - Palliative & supportive care JO - Palliat Support Care VL - 13 IS - 5 N2 - OBJECTIVE: Thiamine-related encephalopathy (Wernicke's encephalopathy) is a neuropsychiatric syndrome caused by a vitamin B1 (thiamine) deficiency often associated with alcoholism. Cancer predisposes patients to thiamine deficiency unrelated to alcoholism, though many cases are missed clinically. The present report adds to the literature on thiamine as a palliative tool for thiamine-related encephalopathy (TRE) in cancer. METHOD: From a larger series of TRE in cancer, we report on three cases with terminal illness. RESULTS: Case 1. A 61-year old woman with Hodgkin's lymphoma developed TRE over 13 days. Precipitants included a hypermetabolic state in the background of subacute thiamine deficiency. Diagnosis was supported by abnormal serum thiamine and positive MRI findings. Mental status improved within 36 hours of initiating thiamine 500 mg IV t.i.d. Case 2. A 68-year-old man with colon cancer metastatic to liver and bone developed TRE precipitated by C. difficile-related diarrhea superimposed on 3 months of low appetite and weight loss. Diagnosis was supported by abnormal serum thiamine, and thiamine 500 mg IV t.i.d. was initiated. Improvements in mental status began within 36 hours. Case 3. An 80-year-old man with squamous cell carcinoma developed TRE precipitated by systemic infection in the context of three weeks of dysphagia. Antibiotic treatment did not reverse his cognitive symptoms, and a diagnosis of TRE was made based on operationalized criteria. Thiamine 100 mg IV daily did not reverse his symptoms. On his 30th day of admission, thiamine was increased to 500 mg IV t.i.d., resulting in a rapid reversal of altered mental status. SIGNIFICANCE OF RESULTS: This report adds to the list of cancer types in which TRE/Wernicke's encephalopathy has been reported. It supports the use of higher doses of thiamine than are typically recommended in North America. Improvement following treatment allowed patients to engage with family and treatment teams prior to death. SN - 1478-9523 UR - https://www.unboundmedicine.com/medline/citation/25339378/Palliative_treatment_of_thiamine_related_encephalopathy__Wernicke's_encephalopathy__in_cancer:_A_case_series_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -