Medication-induced peripheral neuropathy
- 478 Downloads
Although not very common, medication-induced neuropathy is a treatable condition and, therefore, is important to identify. Medications continue to grow in number and expand in usage; consequently, toxic neuropathy continues to be relevant to neurologists. Many agents have toxicities that are tolerated because the treatments are necessary, such as therapies for HIV and malignancy. Additional agents to prevent or ameliorate the toxic neuropathy are being sought and trials are ongoing. Certain patients, however, may be at high risk for peripheral nerve toxicity due to genetic factors or another underlying neuropathy. Newer drug-delivery methods, such as viral transfection, may produce less toxicity in the future. The underlying pathomechanisms remain incompletely elucidated; however, apoptosis is emerging as an important final pathway in some forms of toxic neuropathy. Although most cases demonstrate acute or subacute onset after exposure, recent experiences with statin drugs raise the possibility of occult toxic causes of chronic idiopathic neuropathy.
KeywordsNeuropathy Nerve Growth Factor Peripheral Neuropathy Thalidomide Suramin
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.Jain KK: Drug-induced peripheral neuropathies. In Drug-induced Neurological Disorders, edn 2. Edited by Jain KK. Seattle: Hogrefe & Huber; 2001:263–294.Google Scholar
- 2.Chaudhry V, Chaudhry M, Crawford TO, Griffin JW: Toxic neuropathy in patients with pre-existing neuropathy [abstract]. Neurology2002, 58(suppl 3):A19.Google Scholar
- 7.Wang MS, Fang G, Culver DG, et al.: The WldS protein protects against axonal degeneration: a model of gene therapy for peripheral neuropathy. Ann Neurol 2001, 50:773–779. Important example of uncovering a specific example of genetic susceptibility to toxic neuropathy and early attempt to apply therapeutically in an in vitro model.PubMedCrossRefGoogle Scholar
- 11.Makhalova J, Katsarava Z, Liedert B, et al.: Cisplatin-induced neurotoxicity: formation and repair of specific cisplatin-DNA lesions in different cell types of nervous tissue in wild type and XPC-knockout mice [abstract]. Neurology 2002, 58(suppl 3):A19.Google Scholar
- 18.Openshaw H, Slatkin N, Beamon K, et al.: The effect of amifostine on peripheral neuropathy after high dose paclitaxel [abstract]. Neurology 2002, 58(suppl 3):A50.Google Scholar
- 22.Chattopadhyay M, Wolfe D, Huang S, et al.: In vivo gene therapy for pyridoxine-induced neuropathy by herpes simplex virus-mediated gene transfer of neurotrophin-3. Ann Neurol 2002, 51:19–27. Avoided limitations of systemic administration by direct dorsal root ganglion delivery through disabled herpes-simplex virus in live rats. Neurotrophin-3 severely attenuated pyridoxine toxicity without measurable serum levels.PubMedCrossRefGoogle Scholar
- 36.Gaist D, Jeppesen U, Andersen M, et al.: Statins and risk of polyneuropathy: a case-control study. Neurology 2002, 58:1333–1337. Well-designed study applying newer methods to express neurotoxicity risk. The researchers tapped governmental records to quantify the small but significant numbers. Raises question of unsuspected medication-induced basis of some idiopathic neuropathy. Best evidence to date of neuropathy link to statins.PubMedGoogle Scholar
- 46.Martin C, Solders G, Sonnerborg A, et al.: Antiretroviral therapy may improve sensory function in HIV-infected patients: a pilot study. Neurology 2000, 54:2120–2127. Study demonstrated that lowering RNA viral load through antiretroviral therapy can improve overall sensory function measures, regardless of whether neuropathy-inducing drugs were taken or not.PubMedGoogle Scholar