An 18-year-old male patient with MELAS phenotype and 2 previous episodes of cerebral
stroke, recurrent seizures and nephropathy, was treated with creatine monohydrate
after the acute onset of psychomental regression and changing states of somnolence
and aggressive and agitated behaviour. These symptoms disappeared completely after
4 weeks of treatment with creatine after which the patient regained all his previous
mental abilites. Brain (white matter) proton magnetic resonance spectroscopy (chemical
shift imaging) performed at 6 and 12 months of treatment showed lactic acid (Lac)
accumulation and high creatine (Cr) levels in relation to choline-containing compounds
(Cho). Urinary creatinine excretion as an indicator of the muscle and brain creatine
pool increased upon short-term (12 days) high-dosage creatine supplementation (20
g per day) while plasma creatinine concentrations as possible indicators both of increasing
creatine pool and of renal insufficiency increased during the course (28 months) of
low-dosage creatine supplementation (5 g per day). Deterioration of renal function
was finally indicated by urea retention and by impairment of renal creatinine clearance.
These observations suggest that creatine supplementation may have a neuroprotective
effect in patients with MELAS and episodes of acute mental deterioration. Adverse
effects of creatine supplementation on renal function must be considered especially
in patients with preexisting nephropathy.
Creatine Monohydrate - Mitochondrial Encephalopathy - Stroke - Renal Insufficiency
