{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:37:01Z","timestamp":1793673421713,"version":"4.5.1"},"reference-count":6,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2022,11,13]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older patients with impaired renal function and is characterised by a combination of confusion and psychiatric changes. Seizures, myoclonus and dysarthria may also occur. Critically, peritoneal dialysis has little effect on reversing the toxic effects of aciclovir. We describe a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir. She was ultimately diagnosed with aciclovir-induced neurotoxicity, confirmed by an elevated serum CMMG concentration. This condition is likely to be underdiagnosed and the neurologist\u2019s primary challenge is differentiating aciclovir-induced neurotoxicity from viral encephalitis.<\/jats:p>","DOI":"10.1136\/pn-2022-003597","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T13:20:46Z","timestamp":1670505646000},"page":"157-159","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Aciclovir-induced neurotoxicity"],"prefix":"10.1136","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3993-046X","authenticated-orcid":false,"given":"Frederick William","family":"Vonberg","sequence":"first","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Neurology, Chelsea and Westminster Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Dawson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Neurology, Chelsea and Westminster Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"2025090409533359000_23.2.157.1","article-title":"Concurrent nephrotoxicity and neurotoxicity induced by oral valacyclovir in a patient with previously normal kidney function","volume":"14","author":"Abuhelwa","year":"2022","journal-title":"Cureus"},{"key":"2025090409533359000_23.2.157.2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0002-9343(82)90089-4","article-title":"Acyclovir clinical pharmacology","volume":"73","author":"Lietman","year":"1982","journal-title":"Am J Med"},{"key":"2025090409533359000_23.2.157.3","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl067"},{"key":"2025090409533359000_23.2.157.4","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/jcpt.13464","article-title":"Neurotoxicity associated with acyclovir and valacyclovir: a systematic review of cases","volume":"46","author":"Brandariz-Nu\u00f1ez","year":"2021","journal-title":"J Clin Pharm Ther"},{"key":"2025090409533359000_23.2.157.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39408.393137.BE"},{"key":"2025090409533359000_23.2.157.6","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1159\/000189332","article-title":"Clinical pharmacokinetics of oral acyclovir in patients on continuous ambulatory peritoneal dialysis","volume":"74","author":"Stathoulopoulou","year":"1996","journal-title":"Nephron"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2022-003597","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T16:53:42Z","timestamp":1757004822000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2022-003597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,8]]},"references-count":6,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,3,20]]},"published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1136\/pn-2022-003597"],"URL":"https:\/\/doi.org\/10.1136\/pn-2022-003597","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,8]]}}}