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Der Schmerz

, Volume 22, Issue 1, pp 16–23 | Cite as

Schmerzhaftes Hyperexzitabilitätssyndrom unter Oxaliplatin-haltiger Chemotherapie

Klinik, Pathophysiologie und Therapieoptionen
  • T. Kowalski
  • C. Maier
  • A. Reinacher-Schick
  • U. Schlegel
Übersichten

Zusammenfassung

Das Platinderivat Oxaliplatin wird bei der Chemotherapie des kolorektalen Karzinoms eingesetzt. Sein Nebenwirkungsprofil unterscheidet sich von dem der anderen Platinderivate Cisplatin und Carboplatin. Oxaliplatin verursacht wie alle anderen Platinderivate eine chronische periphere sensible Neuropathie (PSN). Eine Besonderheit ist das akute, sehr schmerzhafte Hyperexzitabilitätssyndrom (HES) mit durch Kälte ausgelösten Parästhesien, Dysästhesien und einer Myotonie, die schmerztherapeutische Interventionen erforderlich machen können. Offenbar liegt dem HES eine gesteigerte neuronale Erregbarkeit als Folge einer Beeinflussung spannungsabhängiger Natriumkanäle durch eine Störung der Kalziumkinetik zugrunde. Therapeutische Optionen zur Kupierung des HES bestehen in der Anwendung von Kalzium und Magnesium, des Serotonin- und Noradrenalin-Rückaufnahmehemmers (SNRI) Venlafaxin und des Thiophosphats Amifostin.

Schlüsselwörter

Oxaliplatin Neurotoxizität Hyperexzitabilität Schmerz Dysästhesie 

Painful hyperexcitability syndrome with oxaliplatin containing chemotherapy

Clinical features, pathophysiology and therapeutic options

Abstract

The platinum derivative oxaliplatin is widely used in colorectal cancer. Its side effects differ from those of the other platinum compounds cisplatin and carboplatin. An acute, painful hyperexcitability syndrome (HES) accompanied by cold induced paresthesia, dysesthesia and myotonia is unique to oxaliplatin, whereas a chronic, peripheral sensory neuropathy (PSN) can be caused by all platinum compounds. It is believed that HES is the result of peripheral nerve hyperexcitability as a consequence of voltage-gated sodium channel dysfunction, which may be caused by calcium level imbalance. Therapeutic options for HES are the administration of calcium and magnesium, the serotonin and noradrenaline reuptake inhibitor (SNRI) venlafaxine and the thiophosphate amifostine.

Keywords

Oxaliplatin Neurotoxicity Hyperexcitability Pain Dysesthesia 

Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Die Autoren versichern, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung des Themas produktneutral.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • T. Kowalski
    • 1
  • C. Maier
    • 2
  • A. Reinacher-Schick
    • 3
  • U. Schlegel
    • 1
  1. 1.Neurologische KlinikKnappschaftskrankenhaus Bochum-Langendreer, Ruhr-Universität BochumBochumDeutschland
  2. 2.Abteilung für SchmerztherapieBG Klinken Bergmannsheil BochumBochumDeutschland
  3. 3.Medizinische KlinikKnappschaftskrankenhaus Bochum-Langendreer, Ruhr-Universität BochumBochumDeutschland

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