Medications and substances of abuse
James W. Albers, Stanley Berent in Neurobehavioral Toxicology: Neurological and Neuropsychological Perspectives, 2005
The neuropathy produced by n-hexane is a classical dying-back sensorimotor neuropathy. It is clinically characterized by distal weakness, stocking– glove sensory loss, and absent ankle reflexes. Involvement may be severe, as in the case presentation, with profound weakness and sensory loss. In general, there is excellent agreement about the clinical features of n-hexane neuropathy. However, some reports emphasize motor findings, whereas other reports refer to predominant distal sensory loss. In most reports, motor signs predominate over sensory signs, but a pure motor neuropathy without any sensory involvement is considered unusual and inconsistent with the well-documented sural neuropathological abnormalities. The continued progression of weakness for weeks to months after cessation of exposure is typical of many toxic neuropathies. This progression is referred to as ‘coasting.’ Onset is characterized by distal numbness, slowly progressive sensory loss, and reduced or absent ankle reflexes. Further progression results in weakness and atrophy of intrinsic hand and foot muscles.
HIV and AIDS Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Treatment should include the discontinuation of drugs that cause peripheral neuropathy. About two thirds of patients will eventually respond to NRTI discontinuation, but there may be a “coasting phenomenon,” where the neuropathy worsens for 1 to 6 weeks. This is followed by gradual improvement, with recovery in 3 to 19 weeks (Nardin & Freeman, 2004). Remaining symptoms may be due to irreversible toxicity or concomitant DSP. In a small randomized, double-blind, placebo-controlled study, lamotrigine use was associated with a substantial decrease in pain compared with placebo in the treatment of HIV neuropathy. A larger and more recent study demonstrated that the beneficial effect of lamotrigine was seen in patients with ATN rather than DSP. The starting dose was 25 mg given either daily or every other day. Dose escalation occurred over 7 weeks, to reach a maximum of 400 to 600 mg per day in two divided doses. Higher doses were used in patients who were taking drugs known to induce the metabolism of lamotrigine (Simpson et al., 2000, 2003). Recent studies have also shown that nerve growth factor is associated with major improvement of pain compared with placebo. However, there was no improvement in the secondary measures of nerve growth regeneration, and the drug is not commercially available. Amitriptyline, mexiletine, topical capsaicin, acupuncture, 5% lidocaine, and gabapentin may also be useful for treating ATN.
Thalidomide
Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer in Handbook of Systemic Drug Treatment in Dermatology, 2015
Neurological: peripheral neuropathy is a very common, potentially severe effect as it may be irreversible. It generally occurs following long-term use and the risk appears related to cumulative dosage and duration of therapy. However, reports following relatively short-term use also exist, and symptoms may also develop some time after treatment has been stopped. The typical presentation is with symmetrical painful distal paraesthesias. The risk may vary with disease and is higher in nodular prurigo and Behçet’s disease. It may also be greater in females and the elderly. All patients require careful monitoring for symptoms of neuropathy including pain, tingling, numbness, abnormal co-ordination or weakness. Expert neurological assessment should be sought if these symptoms develop.
Isolating the Superficial Peroneal Nerve Motor Branch to the Peroneus Longus Muscle with Concentric Stimulation during Diagnostic Motor Nerve Biopsy
Published in The Neurodiagnostic Journal, 2022
Ashley Rosenberg, Rachel Pruitt, Sami Saba, Justin W. Silverstein, Randy S. D’Amico
Clinical, serologic, electrophysiologic, and imaging data are often insufficient to differentiate cases of motor neuropathy from motor neuron disease or myopathy in patients presenting with focal or diffuse muscle weakness (Joyce et al. 2012; Rosow and Amato 2016). This distinction is particularly relevant since motor neuropathy may be effectively treated with immunomodulating therapy (Eftimov and Van Schaik 2011). Motor nerve biopsy with or without muscle biopsy can be a useful tool to supplement inconclusive data. To maximize the utility of biopsy for diagnostic and therapeutic decisions, clinically affected tissue should be targeted for biopsy when possible. Biopsy of a motor branch of the superficial peroneal nerve to the peroneus longus muscle has been described previously as a convenient and safe technique for muscle/nerve biopsy (D’Amico and Winfree 2017). Although anatomic landmarks can be used for localization during this approach, neurophysiologic monitoring is critical to preserve clinically important postoperative motor function. To date, surgical neurophysiology techniques have not been described for this procedure. We present a case of superficial peroneal nerve biopsy and describe the surgical neurophysiology techniques and findings key to preserving motor function.
Study on autonomic neuropathy of the digestive system caused by bortezomib in the treatment of multiple myeloma
Published in Hematology, 2023
Weiwei Zhao, Juan Liu, Lianjie Wang, Wei Wang
Peripheral neuropathy induced by bortezomib is relatively common. With the in-depth study of the clinical characteristics, pathogenesis and treatment measures of sensory and motor neuropathy, the neurological symptoms can be improved to a certain extent. However, there are no effective prevention and treatment measures for autonomic neuropathy of the digestive system. According to NCI-CTC AE version 5.0 and the results of research, our centre suggests evaluating and classifying the adverse effects of the digestive system induced by bortezomib and adjusting the treatment strategy in time on the basis of the severity of autonomic neuropathy. The details are as follows: the dose or frequency of bortezomib is no need to adjust for grade 1, bortezomib is reduced to 1.0 mg/m2 or administered once a week for grade 2, treatment is suspended until the symptoms are significantly alleviated by one level for grade 3, and treatment is terminated for grade 4. In this study, 26 patients with intestinal obstruction were cured after reducing the dose or frequency of bortezomib as shown in Table 3 and conservative treatment, two patients were ineffective and died after giving up further treatment. Autonomic neuropathy of the digestive system was characterized by rapid progress, severe disease and easy to be ignored. It should be closely monitored, diagnosed and treated early to improve the prognosis of patients.
Enfortumab Vedotin, a fully human monoclonal antibody against Nectin 4 conjugated to monomethyl auristatin E for metastatic urothelial Carcinoma
Published in Expert Opinion on Investigational Drugs, 2019
Bradley A McGregor, Guru Sonpavde
In the phase 2 trial, TRAEs resulted in discontinuation in 12% of patients. Most common related TRAEs were fatigue (50%), alopecia (49%), and decreased appetite (44%). TRAE ≥3 occurring in over 5% of patients included rash (12%), neutropenia (8%), anemia (7%), hyperglycemia (6%), and fatigue (6%.) Peripheral neuropathy, rash, and hyperglycemia were pre-identified as TRAEs of special interest. Treatment-related peripheral neuropathy occurred in ~50% of patients, the majority (94%) were ≤ grade 2 with sensory neuropathy more common than motor neuropathy. Most patients (76%) with peripheral neuropathy had either resolution or only Grade 1 symptoms at last follow-up. Any treatment-related rash occurred in 48% of patients, most of which were low grade (75% ≤Grade 2;) and onset was usually within the first treatment cycle. The rash was manageable with topical emollients and corticosteroids and of all patients who experienced rash, 93% had resolution or improvement at last follow-up. Treatment-related hyperglycemia occurred in few patients and was manageable (11%.). Of those with hyperglycemia at baseline (N = 19) 68% did not develop worsening hyperglycemia. Of those who did develop hyperglycemia, 71% had resolution or improvement at the time of last follow-up and there was one grade 4 toxicity that resolved without the need for long-term therapy. Only one patient required cessation of therapy due to hyperglycemia. There were no treatment-related deaths during the 30-day safety-reporting period [24].
Related Knowledge Centers
- Autonomic Nervous System
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- Nerve
- Sensory Nervous System
- Medication