Disclosures: Albert Park, MD: Nothing to disclose

Case Description: The patient presented with an acute worsening of progressive lower extremity spasticity 4 days after initiating treatment with a dual m-TORC1/2 inhibitor for recurrent atypical meningioma. On exam, he was noted to have near-rigid spasticity in his lower extremities predominantly affecting his bilateral quadriceps, hip adductors, and ankle plantarflexors. An evaluation for potential triggers of his spasticity was unrevealing, including a negative infectious workup and an unremarkable MRI of his total spine. An abdominal x-ray demonstrated mild stool burden, but the patient’s severe spasticity persisted despite an aggressive bowel regimen. An MRI of the brain was notable for a 4-mm increase in the right cingulate meningioma. The patient was trialed on numerous antispastic medications but was unable to tolerate tizanidine, diazepam, gabapentin, or increased doses of baclofen due to significant sedation and altered mental status requiring the use of quetiapine and valproic acid. The dual m-TORC1/2 inhibitor was discontinued, and the patient was initiated on dantrolene.

Setting: Tertiary care adult hospital

Patient: A 44-year-old male with recurrent atypical meningioma.

Assessment/Results: After discontinuation of the patient’s home baclofen and all other centrally acting antispastic medications, his mentation returned to baseline. His pain resolved, and his spasticity returned to near baseline after discontinuation of his dual m-TORC1/2 inhibitor and substitution of baclofen with dantrolene.

Discussion: To our knowledge, this is the first described case in which an mTOR inhibitor may have triggered worsening spasticity. In addition, the patient experienced significant cognitive and behavioral effects from centrally acting antispastic medications. Prior research has shown that patients with CNS tumors are at increased risk for delirium.

Conclusion: mTOR inhibitors are a potential trigger for spasticity. Furthermore, patients with CNS tumors may be more susceptible to adverse CNS effects from centrally acting antispastic medications.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/increased-spasticity-after-treatment-with-dual-m-torc1-2-inhibitor-for-atypical-meningioma-a-case-report/