Would you recommend a specific workup or change in management for patients with severe, persistent deficits from methotrexate leukoencephalopathy?  

In my practice setting, I typically see this as delayed toxicity in adults that is not reversible. In the acute, and particularly pediatric settings, there may be some limited evidence for leucovorin, aminophylline, drugs that modulate NMDA neurotransmission, etc., but usually in adult patients, tre...