Presentation
Among the 18 patients in the overall group who were eligible to be surveyed (those present for a clinic visit within the past year), 14 reported BIPN, and of these, 10 reported ongoing symptoms at the median follow-up of 24 months. [curetoday.com]
Patients usually present with muscle weakness, myalgias, and difficulty in walking. [clinicalgate.com]
My Response Presentation/Physical Findings The patient’s presentation is typical of chemotherapy-induced peripheral neuropathy (CIPN) that is characterized by tingling (71%), numbness (58%), and paresthesias or dysesthesias (45%), or spontaneous burning [hematology.org]
Neuropathies from industrial agents (either from occupational or environmental sources), presenting after either limited or long-term exposure, are insidious. Patients may present with subtle pain or weakness. [emedicine.medscape.com]
Neurologic
- Peripheral Neuropathy
Alcohol-Induced Peripheral Neuropathy, Alcohol-Induced Peripheral Neuropathy, Alcoholic Peripheral Neuropathies, Alcohol-Induced Peripheral Neuropathy, Alcohol Induced Peripheral Neuropathy, Alcohol-Induced Polyneuritides, Alcoholic Polyneuritis, Alcoholic [finto.fi]
Peripheral neuropathy can be caused by medication, and various descriptions have been applied for this condition. [ncbi.nlm.nih.gov]
- Dysesthesia
Patients can present with symmetric, distal, length-dependent, “stocking-glove” distribution of painful paresthesia, dysesthesia, cold sensitivity, allodynia, tingling, and numbness. [clinicalgate.com]
My Response Presentation/Physical Findings The patient’s presentation is typical of chemotherapy-induced peripheral neuropathy (CIPN) that is characterized by tingling (71%), numbness (58%), and paresthesias or dysesthesias (45%), or spontaneous burning [hematology.org]
[…] syndrome; peripheral reflexes are preserved Dimethylaminopropionitrile (DMAP): Industrial exposure has led to prominent urinary and sexual dysfunction, as well as to distal sensory neuropathy Alcohol: Ataxia and other systemic symptoms may accompany dysesthesia [emedicine.medscape.com]
Workup
Routine workup for diabetes, vasculitis, celiac disease, metabolic and nutritional disorders was negative. [neurologyindia.com]
[…] blood Vitamin B-12 Monoclonal gammopathy of unknown significance Axonal neuropathy Cryoglobins and hepatitis C evaluation Immunofixation (for paraneoplastic neuropathy) Cerebrospinal fluid (CSF) protein level: Usually normal in toxic neuropathy See Workup [emedicine.medscape.com]
Treatment
Neuropathy is a universal and dose-limiting factor during treatment with vinca alkaloids, but is otherwise a rare complication of drug therapy. [ncbi.nlm.nih.gov]
There is currently no cure for CIPN, but there are treatments that can help to ease the symptoms. Treatment options include medication, physical therapy, and acupuncture. [winsantor.com]
Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 2011; 377: 914-923. 42. [geneesmiddelenbulletin.com]
Number of treatments required depends on the severity of the condition – as little as 4 or as many as 16 treatments may be required. [portmoodyhealth.com]
Prognosis
Reversal depends on the severity of the neuropathy, intensity and duration of the treatment and existence of causative cofactors, but generally the prognosis is good. [ncbi.nlm.nih.gov]
What is the Prognosis for Drug-Induced Neuropathy? (Outcomes/Resolutions) The prognosis of Drug-Induced Neuropathy is good with adequate treatment and management of the signs and symptoms. [dovemed.com]
Cisplatin neurotoxicity in the treatment of metastatic germ cell tumour: time course and prognosis. Br J Cancer. 2001; 85: 823-826. 16. D’Addario G, Pintilie M, Leighl NB, Feld R, Cerny T, Shepherd FA. [geneesmiddelenbulletin.com]
Clinical prognosis of patients with diagnosed chronic solvent intoxication. Acta Neurol Scand. 1982 May. 65(5):488-503. [Medline]. Antti-Poika M. Overall prognosis of patients with diagnosed chronic organic solvent intoxication. [emedicine.medscape.com]
Glutathione-S-transferase genotypes influence the risk of chemotherapy-related toxicities and prognosis in Korean patients with diffuse large B-cell lymphoma. Cancer Genet Cytogenet. 2010;198(1):40–6. doi: 10.1016/j.cancergencyto.2009.12.004. [biodatamining.biomedcentral.com]
Etiology
Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]
Codes with this note are Etiology codes and must be followed by a Manifestation code or codes. [icd.codes]
(Etiology) The cause of Drug-Induced Neuropathy is the use of medications, which can be toxic to the nerves. [dovemed.com]
Only 24% of all peripheral neuropathies are thought to be secondary to drugs. 13 A sizable proportion of neuropathies are undiagnosed as to etiology. [now.aapmr.org]
In some patients, extensive search for an etiology may fail to uncover the exact cause of neuropathy. Many chemicals are known to cause neuropathy in laboratory animals. [emedicine.medscape.com]
Epidemiology
Causation and causal inference in epidemiology. Am J Public Health 95 (Suppl 1): S144–50, 2005. Dalakas MC. Peripheral neuropathy and antiretroviral drugs. J Periph N Syst 6:14-20, 2001. Gaist D, Jeppesen U, Anderson M, et al. [now.aapmr.org]
Some of these have been associated with neuropathy in clinical epidemiologic studies, confirming their ability to injure the human peripheral nervous system (PNS). [emedicine.medscape.com]
Molecular epidemiology, cancer-related symptoms, and cytokines pathway. Lancet Oncol. 2008;9(8):777–85. doi: 10.1016/S1470-2045(08)70197-9. PubMed PubMed Central View Article Google Scholar Watkins LR, Maier SF. [biodatamining.biomedcentral.com]
Pathophysiology
Pathophysiology of peripheral neuropathic pain: immune cells and molecules. Anesth Analg. 2007;105:838-847. 7. Vilholm OJ, Christensen AA, Zedan AH, Itani M. Drug-induced peripheral neuropathy. Basic Clin Pharmacol Toxicol. 2014;115:185-192. 8. [uspharmacist.com]
A better understanding of the pathophysiology of CIPN and genes associated with predisposition ultimately will prove fruitful in the quest to identify predictive or targetable biomarkers for personalized treatment of this prevalent and debilitating symptom [healio.com]
According to traditional Chinese medicine, disruptions in the flow of “vital energy” (qi) throughout the body are the underlying reason behind certain pathophysiologic conditions. [ascopost.com]
Pathophysiology and management. Med Toxicol 1: 421–427 PubMed Google Scholar Lewis W, Dalakas MC (1995) Mitochondrial toxicity of antiviral drugs. [link.springer.com]
Pathophysiology Neuropathy may be categorized by presentation (ie, motor or sensory symptoms), electrodiagnostic features, and neuroanatomical location within the peripheral nerve (ie, demyelinating or axonal, neuronopathy, ion channel neuropathy, neuromuscular [emedicine.medscape.com]
Prevention
In this MiniReview, the term 'drug-induced peripheral neuropathy' (DIPN) is used with the suggested definition: Damage to nerves of the peripheral nervous system caused by a chemical substance used in the treatment, cure, prevention or diagnosis of a [ncbi.nlm.nih.gov]
Ways to Prevent or Manage Problems Related to Nerve Changes You may be advised to take these steps: Prevent falls. Have someone help you prevent falls around the house. Move rugs out of your path so you will not trip on them. [cancer.gov]
How can I prevent associated constipation? Make sure that you are eating foods high in fibre and drink at least 6-8 glasses of water a day to help prevent constipation. [eviq.org.au]
This intervention is currently being used in a clinical trial investigating prevention strategies for paclitaxel-induced PN. 14 Venlafaxine is the only medication to demonstrate clinical efficacy in preventing oxaliplatin-induced PN, but it is still not [uspharmacist.com]