Cobalamin
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Cobalamin Involuntary movement: 2 case reports In a case series, a 6-month-old male infant and a 13-monthold male infant developed involuntary movements during treatment with cobalamin for megaloblastic anaemia [not all routes stated]. Case 1: The 6-month-old male infant, who presented with chronic cough and dyspnoea, diagnosed with megaloblastic anaemia. He was then treated with parenteral cobalamin [vitamin B12] 10 µg/day for 2 days, then 100 µg/day for 2 days, followed by 1000 µg/day for 1 week. Additionally, he received erythrocyte suspension for tachycardia and severe anaemia. However, on day 5 of cobalamin therapy, he developed generalised tremors and myoclonus in hands, feet, tongue and lips. He was then found to have involuntary movements secondary to cobalamin therapy. Treatment with piracetam was initiated on the seventh day of cobalamin therapy. Subsequently, his myoclonus and tremor disappeared. Treatment with pirasetam was interrupted after 3 weeks. One month post the initiation of cobalamin, his megaloblastic anaemia improved. At 18 months of age, his serum vitamin B12 level, neurologic development, Ig levels and complete blood count were normal. Case 2: The 13-months-old male infant, who presented with weakness, fatigue, recurrent bronchiolitis and megaloblastic anaemia, started receiving SC cobalamin 100 µg/day for 1 week, then 100 µg/day every other day for 2 weeks, then 100 µg/day twice a week for 1 week, followed by 100 µg once a week for 4 weeks. However, on day 5 of cobalamin therapy, he developed tremors and myoclonus in right wrist, hands, arms and legs. He was then found to have involuntary movements secondary to cobalamin therapy. Thus, treatment with piracetam was initiated. During the first week of piracetam treatment, his tremors and myoclonus disappeared by gradually decreasing and ended on day 6. During 6 month follow up, his neurologic examination and serum vitamin B12 level were found to be normal. Author comment: "We thought that the involuntary movements were due to [cobalamin] therapy". Tosun A, et al. Involuntary movement in infants during vitamin B12 treatment. Turkish Journal of Hematology 28: 317-322, No. 4, Jan 2011. Available from: 803444264 URL: http://doi.org/10.5152/tjh.2011.18 - Turkey
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Reactions 4 Jan 2020 No. 1785
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