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Cuneo A, Murinova N. Headache Management in Individuals with Brain Tumor. Semin Neurol 2024; 44:74-89. [PMID: 38183973 DOI: 10.1055/s-0043-1777423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Headache occurs commonly in individuals diagnosed with cerebral neoplasm. Though the features of a brain tumor-associated headache may vary, a progressive nature of headache and a change in headache phenotype from a prior primary headache disorder often are identified. Pathophysiologic mechanisms proposed for headache associated with brain tumor include headache related to traction on pain-sensitive structures, activation of central and peripheral pain processes, and complications from surgical, chemotherapeutic and/or radiotherapy treatment(s). Optimization of headache management is important for an individual's quality of life. Treatments are based upon patient-specific goals of care and may include tumor-targeted medical and surgical interventions, as well as a multimodal headache treatment approach incorporating acute and preventive medications, nutraceuticals, neuromodulation devices, behavioral interventions, anesthetic nerve blocks, and lifestyles changes.
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Affiliation(s)
- Ami Cuneo
- Department of Neurology, University of Washington, Seattle, Washington
| | - Natalia Murinova
- Department of Neurology, University of Washington, Seattle, Washington
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2
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Argilés JM, López-Soriano FJ, Stemmler B, Busquets S. Cancer-associated cachexia - understanding the tumour macroenvironment and microenvironment to improve management. Nat Rev Clin Oncol 2023; 20:250-264. [PMID: 36806788 DOI: 10.1038/s41571-023-00734-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Cachexia is a devastating, multifactorial and often irreversible systemic syndrome characterized by substantial weight loss (mainly of skeletal muscle and adipose tissue) that occurs in around 50-80% of patients with cancer. Although this condition mainly affects skeletal muscle (which accounts for approximately 40% of total body weight), cachexia is a multi-organ syndrome that also involves white and brown adipose tissue, and organs including the bones, brain, liver, gut and heart. Notably, cachexia accounts for up to 20% of cancer-related deaths. Cancer-associated cachexia is invariably associated with systemic inflammation, anorexia and increased energy expenditure. Understanding these mechanisms is essential, and the progress achieved in this area over the past decade could help to develop new therapeutic approaches. In this Review, we examine the currently available evidence on the roles of both the tumour macroenvironment and microenvironment in cancer-associated cachexia, and provide an overview of the novel therapeutic strategies developed to manage this syndrome.
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Affiliation(s)
- Josep M Argilés
- Cancer Research Group, Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain.
| | - Francisco J López-Soriano
- Cancer Research Group, Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
| | | | - Silvia Busquets
- Cancer Research Group, Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
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Hamdan DI, Salah S, Hassan WHB, Morsi M, Khalil HMA, Ahmed-Farid OAH, El-Shiekh RA, Nael MA, Elissawy AM. Anticancer and Neuroprotective Activities of Ethyl Acetate Fractions from Morus macroura Miq. Plant Organs with Ultraperformance Liquid Chromatography-Electrospray Ionization-Tandem Mass Spectrometry Profiling. ACS OMEGA 2022; 7:16013-16027. [PMID: 35571826 PMCID: PMC9096986 DOI: 10.1021/acsomega.2c01148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Column chromatography afforded the isolation of seven secondary metabolites (1-(2,4,6-trihydroxy phenyl)-ethanone-4-O-β-d-glucopyranoside, naringenin-7-O-β-d-glucopyranoside, kaempferol-3-O-α-l-rhamnoside, kaempferol-3-O-β-d-glucopyranoside, quercetin-3-O-β-d-glucopyranoside, quercetin-3-O-β-d-galactopyranoside, rutin) from the ethyl acetate (ET) fractions of Morus macroura Miq. stems (S), leaves (L), and fruits (F). Their identification based on ultraviolet (UV), electron ionization (EI), electrospray ionization-mass spectrometry (ESI-MS), and 1D and 2D NMR data. In addition, profiling of ET fractions using ultraperformance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) resulted in the identification of 82 compounds belonging to different classes, mainly polyphenolic constituents. Chemical profiling as well as molecular docking directed us to biological evaluation. Interestingly, the ET-L fraction exhibited a robust cytotoxic activity against HepG-2, MCF-7, and HELA cell lines. Also, it displayed a neuromodulatory activity against cisplatin neurotoxicity in rats by ameliorating the neurobehavioral dysfunction visualized in the open field and Y-maze test and modulating the neurochemical parameters such as brain amino acid levels (glutamate, aspartate, serine, and histidine), oxidative stress markers (GSH, MDA, and 8-hydroxy-2'-deoxyguanosine), and purinergic cell energy (adenosine triphosphate (ATP) and adenosine monophosphate (AMP)). In conclusion, the isolated compounds (kaempferol-3-O-β-glucoside and quercetin-3-O-β-glucoside) from the ET-L fraction could serve as potent anticancer agents due to their strong antioxidant, in vitro cytotoxicity, and in vivo neuroprotective activity.
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Affiliation(s)
- Dalia Ibrahim Hamdan
- Department
of Pharmacognosy, Faculty of Pharmacy Menoufia
University, Shibin
Elkom 32511, Egypt
| | - Samia Salah
- Department
of Pharmacognosy, Faculty of Pharmacy, Zagazig
University, Zagazig 44519, Egypt
| | | | - Mai Morsi
- Department
of Pharmacognosy, Faculty of Pharmacy, Zagazig
University, Zagazig 44519, Egypt
| | - Heba Muhammed Ali Khalil
- Department
of Veterinary Hygiene and Management, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | | | - Riham Adel El-Shiekh
- Department
of Pharmacognosy, Faculty of Pharmacy, Cairo
University, Kasr el Aini
Street, Cairo 11562, Egypt
| | - Manal AbdElaziz Nael
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Tanta University, Tanta 31527, Egypt
| | - Ahmed Mohamed Elissawy
- Pharmacognosy
Department, Faculty of Pharmacy, Ain Shams
University, Abbassia, Cairo 11566, Egypt
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Kandeil MA, Gomaa SB, Mahmoud MO. The effect of some natural antioxidants against cisplatin-induced neurotoxicity in rats: behavioral testing. Heliyon 2020; 6:e04708. [PMID: 32885073 PMCID: PMC7452551 DOI: 10.1016/j.heliyon.2020.e04708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Cisplatin (CP) is a common antineoplastic agent widely used to treat a broad spectrum of cancers. However, its usage for cancer treatment was restricted due to various side effects such as neurotoxicity, nephrotoxicity, hepatotoxicity and ototoxicity. Neurotoxicity in patients who have undergone a complete course of chemotherapy is clinically evident. CP administration caused problems in rats with memory and learning. Methods The effect of combination of CP with either thymoquinone (TQ) or geraniol (Ger) on cell viability of human breast cancer cells (MCF-7) was detected by MTT assay. Forty male Wistar albino rats, healthy and adult, were divided into four groups: normal control, CP-treated group, CP + TQ-treated group and CP + Ger-treated group. Results Our results demonstrated that prophylactic treatment with either TQ or Ger plus CP enhanced the anticancer effect of CP in MCF-7 cell line. In vivo study showed that CP-treated rats had higher depressives like behavior in open field and Morris water maze test while prophylactic treatment with either TQ or Ger and CP significantly enhanced the performance of depressive-like behavior. Also, histopathological evaluation of brain tissues proved the neurotoxic effect of CP and the possible protective activity of either TQ or Ger. Conclusion The findings of the present work revealed that TQ or Ger along with CP may enhance the antitumor effect of CP. Also, spontaneous administration of CP with either TQ or Ger as natural antioxidants may prevent CP-induced neurotoxicity in rats through diminishing the memory and learning impairment.
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Affiliation(s)
- Mohamed A Kandeil
- Department of Biochemistry, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, 62511, Egypt
| | - Safaa B Gomaa
- Department of Biochemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt
| | - Mohamed O Mahmoud
- Department of Biochemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt
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Guzmán DC, Brizuela NO, Herrera MO, Olguín HJ, Peraza AV, García EH, Jiménez FT, Mejía GB. Cytarabine and Ferric Carboxymaltose (Fe+3) Increase Oxidative Damage and Alter Serotonergic Metabolism in Brain. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2019; 18:149-155. [PMID: 30484410 DOI: 10.2174/1871527318666181128144343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/07/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND & OBJECTIVE The purpose of this study was to measure the effect on brain biomarkers after treatment with anticancer compounds - cytarabine (CT) and ferric carboxymaltose (FC) (Fe+3) in Wistar rats. METHODS The Wistar rats were treated as follows: group 1 (control), NaCl 0.9%; group 2, CT (25 mg/k), group 3, FC(Fe+3) (50 mg/k) and group 4, CT + FC(Fe+3). The animals were sacrificed and their brains were obtained and used to measure lipoperoxidation (TBARS), H2O2, Na+, K+ ATPase, glutathione (GSH), serotonin metabolite (5-HIAA) and dopamine. The results indicated an enhancement of lipid peroxidation in the cortex and striatum of groups treated with FC(Fe+3) and CT, while GSH decreased in the cortex of group treated with CT + FC(Fe+3). Dopamine decreased in the cortex of the rats that received CT, while in the striatum, 5HIAA increased in all groups. RESULTS & CONCLUSION These results suggest that the treatment with CT and FC(Fe+3) boosted oxidative stress and led to an alteration in momoamine concentrations in the brain.
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Affiliation(s)
| | | | - Maribel Ortíz Herrera
- Laboratory of Experimental Bacteriology, National Institute of Pediatrics, Mexico City, Mexico
| | - Hugo Juárez Olguín
- Laboratory of Pharmacology. National Institute of Pediatrics, and Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Ernestina Hernández García
- Laboratory of Pharmacology. National Institute of Pediatrics, and Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Francisca Trujillo Jiménez
- Laboratory of Pharmacology. National Institute of Pediatrics, and Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Zhuo M, Gorgun MF, Englander EW. Neurotoxicity of cytarabine (Ara-C) in dorsal root ganglion neurons originates from impediment of mtDNA synthesis and compromise of mitochondrial function. Free Radic Biol Med 2018; 121:9-19. [PMID: 29698743 PMCID: PMC5971160 DOI: 10.1016/j.freeradbiomed.2018.04.570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/12/2018] [Accepted: 04/21/2018] [Indexed: 12/18/2022]
Abstract
Peripheral Nervous System (PNS) neurotoxicity caused by cancer drugs hinders attainment of chemotherapy goals. Due to leakiness of the blood nerve barrier, circulating chemotherapeutic drugs reach PNS neurons and adversely affect their function. Chemotherapeutic drugs are designed to target dividing cancer cells and mechanisms underlying their toxicity in postmitotic neurons remain to be fully clarified. The objective of this work was to elucidate progression of events triggered by antimitotic drugs in postmitotic neurons. For proof of mechanism study, we chose cytarabine (ara-C), an antimetabolite used in treatment of hematological cancers. Ara-C is a cytosine analog that terminates DNA synthesis. To investigate how ara-C affects postmitotic neurons, which replicate mitochondrial but not genomic DNA, we adapted a model of Dorsal Root Ganglion (DRG) neurons. We showed that DNA polymerase γ, which is responsible for mtDNA synthesis, is inhibited by ara-C and that sublethal ara-C exposure of DRG neurons leads to reduction in mtDNA content, ROS generation, oxidative mtDNA damage formation, compromised mitochondrial respiration and diminution of NADPH and GSH stores, as well as, activation of the DNA damage response. Hence, it is plausible that in ara-C exposed DRG neurons, ROS amplified by the high mitochondrial content shifts from physiologic to pathologic levels signaling stress to the nucleus. Combined, the findings suggest that ara-C neurotoxicity in DRG neurons originates in mitochondria and that continuous mtDNA synthesis and reliance on oxidative phosphorylation for energy needs sensitize the highly metabolic neurons to injury by mtDNA synthesis terminating cancer drugs.
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Affiliation(s)
- Ming Zhuo
- Division of Neurosurgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Murat F Gorgun
- Division of Neurosurgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ella W Englander
- Division of Neurosurgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
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7
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Abdelkader NF, Saad MA, Abdelsalam RM. Neuroprotective effect of nebivolol against cisplatin-associated depressive-like behavior in rats. J Neurochem 2017; 141:449-460. [DOI: 10.1111/jnc.13978] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/18/2017] [Accepted: 02/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Noha F. Abdelkader
- Department of Pharmacology and Toxicology; Faculty of Pharmacy; Cairo University; Cairo Egypt
| | - Muhammed A. Saad
- Department of Pharmacology and Toxicology; Faculty of Pharmacy; Cairo University; Cairo Egypt
| | - Rania M. Abdelsalam
- Department of Pharmacology and Toxicology; Faculty of Pharmacy; Cairo University; Cairo Egypt
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A Case of Subacute Encephalopathy Developing After Treatment With Clofarabine and Methotrexate That Resolved With Corticosteroids. Am J Ther 2017; 23:e937-40. [PMID: 24987945 DOI: 10.1097/mjt.0000000000000091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the case of a 24-year-old woman with relapsed acute undifferentiated leukemia who developed subacute encephalopathy with hemiparesis and dysarthria after treatment with high dose and intrathecal methotrexate, clofarabine, and cytarabine that resolved rapidly and completely after the administration of corticosteroids. We hypothesize that clofarabine might predispose to methotrexate-induced central nervous system toxicity by increasing endothelial permeability (capillary leak syndrome) and suggest that corticosteroids are effective in the treatment of this type of encephalopathy.
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Spreafico A, Delord JP, De Mattos-Arruda L, Berge Y, Rodon J, Cottura E, Bedard PL, Akimov M, Lu H, Pain S, Kaag A, Siu LL, Cortes J. A first-in-human phase I, dose-escalation, multicentre study of HSP990 administered orally in adult patients with advanced solid malignancies. Br J Cancer 2015; 112:650-9. [PMID: 25625276 PMCID: PMC4333497 DOI: 10.1038/bjc.2014.653] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/04/2014] [Accepted: 12/04/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Heat-shock protein 990 (HSP990) is a potent and selective synthetic small-molecule HSP90 inhibitor. The primary objectives of this phase I first-in-human study were to determine dose-limiting toxicities (DLTs), maximum-tolerated dose (MTD) and recommended phase II dose (RP2D). Secondary objectives included characterisation of the safety profile, pharmacokinetics (PKs) and pharmacodynamics (PDs). METHODS Heat-shock protein 990 was administered orally once or two times weekly on a 28-day cycle schedule in patients with advanced solid tumours. Dose escalation was guided by a Bayesian logistic regression model with overdose control. RESULTS A total of 64 patients were enrolled. Fifty-three patients received HSP990 once weekly at 2.5, 5, 10, 20, 30, 50 or 60 mg, whereas 11 patients received HSP990 two times weekly at 25 mg. Median duration of exposure was 8 weeks (range 1-116 weeks) and 12 patients remained on treatment for >16 weeks. Dose-limiting toxicities occurred in seven patients and included diarrhoea, QTc prolongation, ALT/AST elevations and central neurological toxicities. The most common drug-related adverse events were diarrhoea, fatigue and decreased appetite. Further dose escalation beyond 60 mg once weekly was not possible owing to neurological toxicity. Rapid absorption, no drug accumulation and large interpatient variability in PK exposures were observed. No objective responses were seen; 25 patients had a best overall response of stable disease. CONCLUSIONS Heat-shock protein 990 is relatively well tolerated, with neurological toxicity being the most relevant DLT. The single agent MTD/RP2D of HSP990 was declared at 50 mg once weekly.
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Affiliation(s)
- A Spreafico
- Drug Development Program, UHN – Princess Margaret Cancer Centre, Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J-P Delord
- Institut Claudius Regaud, Toulouse, France
| | - L De Mattos-Arruda
- Vall d'Hebron University Hospital, Hospital and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Y Berge
- Institut Claudius Regaud, Toulouse, France
| | - J Rodon
- Vall d'Hebron University Hospital, Hospital and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - E Cottura
- Institut Claudius Regaud, Toulouse, France
| | - P L Bedard
- Drug Development Program, UHN – Princess Margaret Cancer Centre, Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Akimov
- Novartis Pharma AG, Basel, Switzerland
| | - H Lu
- Novartis Pharmaceuticals Corp, East Hanover, NJ, USA
| | - S Pain
- Novartis Pharmaceuticals Corp, East Hanover, NJ, USA
| | - A Kaag
- Novartis Pharma AG, Basel, Switzerland
| | - L L Siu
- Drug Development Program, UHN – Princess Margaret Cancer Centre, Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Cortes
- Vall d'Hebron University Hospital, Hospital and Universitat Autonoma de Barcelona, Barcelona, Spain
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Stojanovska V, Sakkal S, Nurgali K. Platinum-based chemotherapy: gastrointestinal immunomodulation and enteric nervous system toxicity. Am J Physiol Gastrointest Liver Physiol 2015; 308:G223-32. [PMID: 25501548 DOI: 10.1152/ajpgi.00212.2014] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The efficacy of chemotherapeutic treatment of colorectal cancer is challenged by severe gastrointestinal side effects, which include nausea, vomiting, constipation, and diarrhea. These symptoms can persist long after the treatment has been ceased. An emerging concept is the ability of platinum-based drugs to stimulate immunity, which is in contrast to conventional chemotherapeutic agents that are immunosuppressive. Here, we review the immunomodulatory aspects of platinum-based anticancer chemotherapeutics and their impact on gastrointestinal innervation. Given the bidirectional communication between the enteric nervous system and gastrointestinal immune system; exploring the consequences of platinum-induced immunogenicity will facilitate better understanding of gut dysfunction caused by chemotherapeutic agents. We propose that the development of future successful chemotherapeutics should rely on targeting the mechanisms underlying long-term gastrointestinal side effects.
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Affiliation(s)
- Vanesa Stojanovska
- College of Health and Biomedicine, Victoria University, Western Centre for Health, Research and Education, St Albans, Victoria, Australia
| | - Samy Sakkal
- College of Health and Biomedicine, Victoria University, Western Centre for Health, Research and Education, St Albans, Victoria, Australia
| | - Kulmira Nurgali
- College of Health and Biomedicine, Victoria University, Western Centre for Health, Research and Education, St Albans, Victoria, Australia
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Adigun RA, Martincigh B, O. Nyamori V, Omondi B, Masimirembwa C, Simoyi RH. Kinetics and mechanistic investigation into the possible activation of imidazolium trans-[tetrachloridodimethylsulfoxideimidazoleruthenate(iii)], NAMI-A, by 2-mercaptoethane sulfonate. Dalton Trans 2014; 43:12943-51. [DOI: 10.1039/c4dt01643b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
NAMI-A is a promising antimetastatic prodrug with high specificity for metastatic cancer cells.
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Affiliation(s)
| | - Bice Martincigh
- School of Chemistry
- University of KwaZulu-Natal Westville Campus
- Durban 4000, Republic of South Africa
| | - Vincent O. Nyamori
- School of Chemistry
- University of KwaZulu-Natal Westville Campus
- Durban 4000, Republic of South Africa
| | - Bernard Omondi
- School of Chemistry
- University of KwaZulu-Natal Westville Campus
- Durban 4000, Republic of South Africa
| | | | - Reuben H. Simoyi
- Department of Chemistry
- Portland State University
- Portland, USA
- School of Chemistry
- University of KwaZulu-Natal Westville Campus
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Gulec M, Oral E, Dursun OB, Yucel A, Hacimuftuoglu A, Akcay F, Suleyman H. Mirtazapine protects against cisplatin-induced oxidative stress and DNA damage in the rat brain. Psychiatry Clin Neurosci 2013; 67:50-8. [PMID: 23279761 DOI: 10.1111/j.1440-1819.2012.02395.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/08/2012] [Accepted: 09/11/2012] [Indexed: 01/05/2023]
Abstract
AIM Cisplatin chemotherapy is associated with neurotoxicity, and oxidative stress might play an important role in the pathogenesis. Mirtazapine may be a preventative agent via its less-known antioxidant properties. The aim of this study was to examine the potential chemoprotective effects of mirtazapine against cisplatin-induced oxidative stress and DNA damage. METHODS Twenty-four rats were divided equally into four groups: control; cisplatin (10 mg/kg i.p.); cisplatin plus mirtazapine (10-30 mg/kg, respectively i.p and p.o.); and mirtazapine (30 mg/kg p.o.). The rats were killed at the end of the 14th day of treatment. Brain tissue was examined with regard to antioxidant/oxidant biochemical parameters. RESULTS Although glutathione (tGSH) and nitric oxide (NO) end product mean scores were found to be statistically higher in the control group when compared with the cisplatin group (72.44% and 61.99% percentage change [PC], respectively), malondialdehyde (MDA), myeloperoxidase (MPO), and 8-hydroxyguanine (8-OH-GUA) mean scores were statistically lower in the control group in comparison with the cisplatin group (-55.48%, -67.99%, and -48.81% PC, respectively; P < 0.01). Finally, tGSH and NO end product levels were restored to normal (85.90% and 55.30% PC, respectively), and MDA, MPO, and 8-OH-GUA were significantly reduced by treatment with mirtazapine (-60.50%, -78.59%, and -38.10% PC, respectively; P < 0.01). CONCLUSION Mirtazapine has chemoprotective effects against cisplatin-induced oxidative stress and DNA damage in the rat brain, which may be attributed to its antioxidant capabilities. It would be useful to investigate whether cisplatin at the desired doses can be given concurrently with mirtazapine.
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Affiliation(s)
- Mustafa Gulec
- Department of Psychiatry, Ataturk University Medical Faculty, Erzurum, Turkey.
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13
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Textor LH, Hedrick J. The Lived Experience of Peripheral Neuropathy after Solid Organ Transplant. Prog Transplant 2012; 22:271-9. [DOI: 10.7182/pit2012703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The immunosuppressants required after transplant cause peripheral neuropathy with an incidence of 10% to 60%. Peripheral neuropathy adversely affects health-related quality of life in other populations. Objective To describe the lived experience of peripheral neuropathy after solid organ transplant. Design A qualitative phenomenological study with semistructured interviews. A purposive sample of 7 solid organ transplant recipients with peripheral neuropathy was recruited from 2 transplant clinics at a large Midwest tertiary care center. Interviews were audio taped and transcribed verbatim. Data were analyzed line-byline and coded by using HyperResearch 2.0. Results Although participants' experiences were similar to those reported by others with peripheral neuropathy, there were also unique differences. Unique to this population was unexpected onset, rapid escalation of symptoms, lack of provider monitoring, and poor provider response to reported symptoms. Their experience demonstrated that peripheral neuropathy diminished health-related quality of life. Four themes emerged from the data: (1) nothing is supposed to happen after transplant; (2) neuropathy causes me more problems than my heart; (3) maybe there is something that could help; and (4) I've learned to live with certain limitations. Conclusion Development of or worsening of peripheral neuropathy after solid organ transplant may decrease health-related quality of life. Follow-up care should include vigilant monitoring for signs of peripheral neuropathy. Providers need to provide early treatment, education, support, empathy, and understanding.
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Affiliation(s)
- Laura Hanssen Textor
- Midwest Neuroscience Institute, Center for the Relief of Pain (LHT), Saint Luke's College of Health Sciences (JH), Kansas City, Missouri
| | - Jane Hedrick
- Midwest Neuroscience Institute, Center for the Relief of Pain (LHT), Saint Luke's College of Health Sciences (JH), Kansas City, Missouri
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Newton HB. Neurological complications of chemotherapy to the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:903-16. [PMID: 22230541 DOI: 10.1016/b978-0-444-53502-3.00031-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
One of the most common complications of chemotherapeutic drugs is toxicity to the central nervous system (CNS). This toxicity can manifest in many ways, including encephalopathy syndromes and confusional states, seizure activity, headache, cerebrovascular complications and stroke, visual loss, cerebellar dysfunction, and spinal cord damage with myelopathy. For many drugs, the toxicity is related to route of administration and cumulative dose, and can vary from brief, transient episodes to more severe, chronic sequelae. However, the neurotoxicity can be idiosyncratic and unpredictable in some cases. Among the antimetabolite drugs, methotrexate, 5-fluorouracil, and cytosine arabinoside are most likely to cause CNS toxicity. Of the alkylating agent chemotherapeutic drugs, the nitrosoureas (e.g., BCNU) and cisplatin most frequently cause toxicity to the CNS, especially when given via the intra-arterial route. Ifosfamide is also likely to cause neurotoxicity at high intravenous doses. Other alkylating agents, such as busulfan, cyclophosphamide, procarbazine, and temozolomide, are better tolerated by the CNS at moderate doses. The retinoid drugs are known to cause severe headaches at high doses. l-Asparaginase can induce an encephalopathy syndrome, as well as cerebrovascular complications such as stroke.
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Affiliation(s)
- Herbert B Newton
- Department of Nedurology, Ohio State University Medical Center, Columbus, OH, USA.
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Impact of oxaliplatin-induced neuropathy: a patient perspective. Support Care Cancer 2012; 20:2959-67. [PMID: 22426503 DOI: 10.1007/s00520-012-1428-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/27/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Dose-limiting neurotoxicity is a major side effect of oxaliplatin treatment, producing initial acute neurotoxicity and chronic neuropathy with increasing exposure. The improvement in survival for patients with early-stage colorectal cancer treated with oxaliplatin has highlighted the need for valid and reliable assessment of peripheral neuropathy. OBJECTIVES The objective of this paper was to explore neuropathic symptoms in oxaliplatin-treated patients as assessed using different methods. METHODS Consecutive symptomatic patients reporting peripheral neuropathy after oxaliplatin chemotherapy for colorectal cancer were interviewed using a semi-structured clinical interview. Neurotoxicity was also assessed using the National Cancer Institute Common Toxicity Criteria scale (clinician-rated), patient 'self-report' questionnaires (PNQ), nerve conduction and clinical assessment. RESULTS Twenty patients were assessed, 12.6 ± 2.8 months after treatment cessation (mean cumulative oxaliplatin dose, 789 mg/m(2)). In 40% of patients, neurotoxicity necessitated early cessation of treatment. Only 10% of patients were designated by clinicians with severe neurotoxicity, whilst, in contrast, patient interviews and self-report questionnaires described significant physical limitations due to neuropathic symptoms in 60% of patients. The majority (85%) of patients had objective evidence of sensory neuropathy with nerve conduction studies. Reports from clinical interviews were strongly correlated with patient self-assessment (Pearson coefficient = 0.790, p < 0.0005). CONCLUSION Given the discrepancies in symptom prevalence highlighted by these findings, the monitoring of oxaliplatin-induced neurotoxicity would benefit from more informative clinical assessment, with inclusion of patient-reported outcome measures. Such an approach would be beneficial in a clinical trial setting to monitor the efficacy of interventions and in prospective studies of survivorship to determine the true burden of peripheral neuropathy in oxaliplatin-treated patients.
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Ullah N, Lee HY, Naseer MI, Ullah I, Suh JW, Kim MO. Nicotinamide inhibits alkylating agent-induced apoptotic neurodegeneration in the developing rat brain. PLoS One 2011; 6:e27093. [PMID: 22164206 PMCID: PMC3229474 DOI: 10.1371/journal.pone.0027093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 10/10/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Exposure to the chemotherapeutic alkylating agent thiotepa during brain development leads to neurological complications arising from neurodegeneration and irreversible damage to the developing central nerve system (CNS). Administration of single dose of thiotepa in 7-d postnatal (P7) rat triggers activation of apoptotic cascade and widespread neuronal death. The present study was aimed to elucidate whether nicotinamide may prevent thiotepa-induced neurodegeneration in the developing rat brain. METHODOLOGY/PRINCIPAL FINDINGS Neuronal cell death induced by thiotepa was associated with the induction of Bax, release of cytochrome-c from mitochondria into the cytosol, activation of caspase-3 and cleavage of poly (ADP-ribose) polymerase (PARP-1). Post-treatment of developing rats with nicotinamide suppressed thiotepa-induced upregulation of Bax, reduced cytochrome-c release into the cytosol and reduced expression of activated caspase-3 and cleavage of PARP-1. Cresyl violet staining showed numerous dead cells in the cortex hippocampus and thalamus; post-treatment with nicotinamide reduced the number of dead cells in these brain regions. Terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) and immunohistochemical analysis of caspase-3 show that thiotepa-induced cell death is apoptotic and that it is inhibited by nicotinamide treatment. CONCLUSION Nicotinamide (Nic) treatment with thiotepa significantly improved neuronal survival and alleviated neuronal cell death in the developing rat. These data demonstrate that nicotinamide shows promise as a therapeutic and neuroprotective agent for the treatment of neurodegenerative disorders in newborns and infants.
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Affiliation(s)
- Najeeb Ullah
- Division of Life Science, College of Natural Sciences (RINS) and Applied Life Science (Brain Korea 21), Gyeongsang National University, Chinju, Republic of Korea
| | - Hae Young Lee
- Division of Life Science, College of Natural Sciences (RINS) and Applied Life Science (Brain Korea 21), Gyeongsang National University, Chinju, Republic of Korea
| | - Muhammad Imran Naseer
- Division of Life Science, College of Natural Sciences (RINS) and Applied Life Science (Brain Korea 21), Gyeongsang National University, Chinju, Republic of Korea
| | - Ikram Ullah
- Division of Life Science, College of Natural Sciences (RINS) and Applied Life Science (Brain Korea 21), Gyeongsang National University, Chinju, Republic of Korea
| | - Joo Won Suh
- Division of Bioscience and Bioinformatics, Myongji University, Namdong, Yongin, Kyonggido, Republic of Korea
| | - Myeong Ok Kim
- Division of Life Science, College of Natural Sciences (RINS) and Applied Life Science (Brain Korea 21), Gyeongsang National University, Chinju, Republic of Korea
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Khan HA, Alhomida AS. A review of the logistic role of L-carnitine in the management of radiation toxicity and radiotherapy side effects. J Appl Toxicol 2011; 31:707-13. [PMID: 21818761 DOI: 10.1002/jat.1716] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/10/2011] [Accepted: 06/10/2011] [Indexed: 02/05/2023]
Abstract
Radiation therapy is a key modality in the treatment of different cancer types. Fatigue is the most common side effect of radiotherapy, while others include nausea, hair loss, skin irritation, anemia, infertility, cardiovascular disease, cognitive impairment and even the development of second cancers. Studies in experimental animals have shown protective effects of carnitine against exposure of various organs to ionizing radiation, whereas carnitine deficiency is known to enhance radiation-induced toxicity. This report summarizes the recent literature on the adverse effects of radiotherapy and the impact of radiation on carnitine homeostasis. Although some studies have demonstrated the prophylactic benefits of carnitine against the toxic effects of chemotherapy, the role of carnitine in the prognosis and management of cancer patients receiving radiotherapy is not clear and needs to be explored.
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Affiliation(s)
- Haseeb Ahmad Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia.
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Fantini M, Gianni L, Tassinari D, Nicoletti S, Possenti C, Drudi F, Sintini M, Bagli L, Tamburini E, Ravaioli A. Toxic encephalopathy in elderly patients during treatment with capecitabine: literature review and a case report. J Oncol Pharm Pract 2010; 17:288-91. [DOI: 10.1177/1078155210374891] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Capecitabine is now-a-days rapidly replacing 5-Fluorouracil in daily clinical practice. Neurologic toxicity during a treatment with fluoropyrimidines, as 5-fluorouracil, represents a well-known side-effect, largely described in literature. Central nervous system (CNS) toxicity, mainly encephalopathy with or without seizures, occurs occasionally even when conventional doses are used. CNS toxicity incidence increases markedly when the blood-brain barrier is either overwhelmed or bypassed (Hildebrand J. Neurological complications of cancer chemotherapy. Curr Opin Oncol 2006; 18: 321—324). Peripheral nervous system (PNS) toxicity is more common because proximal and distal extremities of the peripheral nerves are not protected by a blood-brain like barrier and peripheral neuropathy remains a major limiting factor for the administration of conventional doses of several agents (Saif W, Wood TE, McGee PJ and Diasio RB. Peripheral neuropathy associated with capecitabine, Anticancer Drugs 2004;15: 767—771). Capecitabine is a prodrug of 5-fluorouracil, more easily administered by mouth; its transformation in 5-fluorouracil is performed in the liver. There are only a few reports on the toxic neurological side-effects of capecitabine. We describe in our report a rare case of toxic encephalopathy in a 82-year-old female, with a brief review of literature. In the literature reviewed, we found 12 neurologic episodes due to capecitabine lasting between a few days till some months. All clinical symptoms of the cases described in literature, obtained a complete regression with the discontinuation of capecitabine. A relation was not found with dihydropyrimidine dehydrogenase (DPD) mutation, also if pharmacologic and pharmacogenetic assessment should be done for this drug, especially in old patients. Toxic encephalopathy represents a rare event during capecitabine treatment and on the bases of the data found, is fairly managed in the clinical setting. The knowledge of the natural history of the toxic effect allows the use of the drug also in old patients.
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Affiliation(s)
- Manuela Fantini
- Oncology and Oncohematology Department, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy,
| | - Lorenzo Gianni
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Davide Tassinari
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Stefania Nicoletti
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Cinzia Possenti
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Fabrizio Drudi
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | | | - Laura Bagli
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Emiliano Tamburini
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
| | - Alberto Ravaioli
- Department of Oncology and Oncohematology, Rimini Hospital and Cancer Center of Romagna Meldola (FC), Italy
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Cerri S, Piccolini VM, Santin G, Bottone MG, De Pascali SA, Migoni D, Iadarola P, Fanizzi FP, Bernocchi G. The developmental neurotoxicity study of platinum compounds. Effects of cisplatin versus a novel Pt(II) complex on rat cerebellum. Neurotoxicol Teratol 2010; 33:273-81. [PMID: 20883777 DOI: 10.1016/j.ntt.2010.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/16/2010] [Accepted: 09/22/2010] [Indexed: 11/28/2022]
Abstract
In the field of experimental oncology, many efforts are being carried out to search new platinum-based drugs overcoming the CNS toxicity and drug resistance. One of the adopted strategies is the synthesis of platinum compounds able to form Pt-DNA adducts different from the cisplatin ones or to react with other subcellular targets. In this context a novel Pt(II) complex, [Pt(O,O'-acac)(γ-acac)(DMS)](PtAcacDMS), was synthesized which reacts preferentially with protein thiols or thioethers. In this work we investigated the in vivo effects of cisplatin and PtAcacDMS on normal development. Moreover, to verify the dose-dependence of the effects, different groups of animals were treated with 5 μg/g or 10 μg/g body weight of cisPt and PtAcacDMS. We have focused our attention on the cerebellum because it provides a useful model system to evaluate the outcomes of perinatal treatment with chemotherapeutic agents on key CNS developmental processes such as neural cells proliferation, migration and differentiation. We have demonstrated the ability of both cisPt and PtAcacDMS to reach the brain tissue once injected. The brain platinum content after PtAcacDMS treatment was notably higher (approximately 4-fold as much) than after cisPt. The platinum accumulation in the brain was still considerable 7 days after PtAcacDMS administration. However, compared with cisplatin, PtAcacDMS induces less severe changes on fundamental events of neuroarchitecture development, such as no high apoptotic events, less altered granule cell migration and Purkinje cell dendrite growth, suggesting a low neurotoxicity of this new Pt complex for normal CNS. The mild damages could be attributable to the different subcellular target of this compound as well as to a greater efficiency of the cell repair system to recognize the drug-target adducts and to repair them. Together with the previously demonstrated antineoplastic effectiveness in vitro, the findings here reported suggest PtAcacDMS as a potential alternative to cisplatin indicating, at the same time, that the choice of platinum compounds with new subcellular targets could be a strategy to prevent neurotoxicity induced by cisplatin and overcome drug resistance induced by mutations in the intrinsic apoptotic pathway.
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Affiliation(s)
- Silvia Cerri
- Dipartimento di Biologia Animale, Laboratorio di Biologia Cellulare e Neurobiologia, Università di Pavia, via Ferrata 1, 27100 Pavia, Italy.
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Zadik Y, Vainstein V, Heling I, Neuman T, Drucker S, Elad S. Cytotoxic Chemotherapy-induced Odontalgia: A Differential Diagnosis for Dental Pain. J Endod 2010; 36:1588-92. [DOI: 10.1016/j.joen.2010.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 04/30/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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Hamamoto K, Oriuchi N, Kanazawa T, Higuchi T, Endo K. Mesial temporal sclerosis associated with methotrexate-induced leukoencephalopathy. Pediatr Neurol 2009; 40:306-9. [PMID: 19302946 DOI: 10.1016/j.pediatrneurol.2008.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 08/25/2008] [Accepted: 10/30/2008] [Indexed: 11/19/2022]
Abstract
Mesial temporal sclerosis is a common form of symptomatic, localization-related epilepsy in children and adolescents, but its occurrence with acute lymphoblastic leukemia is rare. We present clinical records and neuroimaging results of a 13-year-old patient with acute lymphoblastic leukemia who developed recurrent partial seizures after an episode of leukoencephalopathy thought to be caused by methotrexate. Neuroradiologic images revealed hippocampal abnormalities consistent with the findings of mesial temporal sclerosis. Mesial temporal sclerosis was not previously reported in acute lymphoblastic leukemia patients with methotrexate-induced leukoencephalopathy. However, our case suggests that the pathogenesis of mesial temporal sclerosis may be associated with methotrexate-induced neurotoxicity.
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Affiliation(s)
- Kouhei Hamamoto
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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James SE, Burden H, Burgess R, Xie Y, Yang T, Massa SM, Longo FM, Lu Q. Anti-cancer drug induced neurotoxicity and identification of Rho pathway signaling modulators as potential neuroprotectants. Neurotoxicology 2008; 29:605-12. [PMID: 18539332 DOI: 10.1016/j.neuro.2008.04.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 03/26/2008] [Accepted: 04/10/2008] [Indexed: 12/20/2022]
Abstract
Many chemotherapy drugs are known to cause significant clinical neurotoxicity, which can result in the early cessation of treatment. To identify and develop more effective means of neuroprotection it is important to understand the toxicity of these drugs at the molecular and cellular levels. In the present study, we examine the effects of paclitaxel (taxol), cisplatin, and methotrexate on primary rat neurons including hippocampal, cortical, and dorsal horn/dorsal root ganglion neuronal cultures. We found that all of these anti-cancer drugs induce substantial neurotoxicity evidenced by neurite degeneration. The neurons are capable of recovering after treatment withdrawal, but taxol exerts a biphasic effect that results in the collapse of processes days after treatment is withdrawn. After cisplatin and methotrexate treatment, we observed the degeneration of neuronal processes including the reduction of dendritic branching, length, and altered growth cone formation, indicating an abnormal arrangement of the actin cytoskeleton consistent with the involvement of Rho family small GTPases. Inhibiting RhoA downstream effector p160 ROCK/Rho kinase using Y-27632, or activating p75 neurotrophin receptor (p75 NTR) using non-peptide mimetic LM11A-31, were able to reverse the degeneration caused by cisplatin and methotrexate. Therefore, the neurotoxicity resulting from exposure to the anti-cancer drugs cisplatin and methotrexate can be alleviated by inhibiting Rho signaling pathway.
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Affiliation(s)
- Sarah E James
- Department of Anatomy and Cell Biology, The Brody School of Medicine at East Carolina University, Greenville, NC 27834, United States
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Cytosine arabinoside affects the heat and capsaicin receptor TRPV1 localisation and sensitivity in human sensory neurons. J Neurooncol 2008; 89:1-7. [DOI: 10.1007/s11060-008-9585-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 03/28/2008] [Indexed: 10/22/2022]
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Filosto M, Rossi G, Pelizzari AM, Buzio S, Tentorio M, Broglio L, Mancuso M, Rinaldi M, Scarpelli M, Padovani A. A high-dose bortezomib neuropathy with sensory ataxia and myelin involvement. J Neurol Sci 2007; 263:40-3. [PMID: 17612569 DOI: 10.1016/j.jns.2007.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 05/22/2007] [Accepted: 05/23/2007] [Indexed: 11/22/2022]
Abstract
Bortezomib, a proteasome inhibitor used in the treatment of multiple myeloma, is known to induce an axonal, dose-dependent neuropathy clinically characterized by pain, paresthesias, burning dysesthesias and numbness. In this study, we describe a patient treated with high-dose bortezomib whose main clinical feature was severe sensory ataxia. Electrodiagnostic studies showed, other than axonal changes, myelin involvement.
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Affiliation(s)
- Massimiliano Filosto
- Clinical Neurology, Section for Neuromuscular Diseases and Neuropathies, University Hospital "Spedali Civili", Brescia, Italy.
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Silver J, Mayer RS. Barriers to pain management in the rehabilitation of the surgical oncology patient. J Surg Oncol 2007; 95:427-35. [PMID: 17377956 DOI: 10.1002/jso.20780] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Virtually every surgical oncology patient faces pain, and it can become a major barrier to rehabilitation and quality of life. Pain must be assessed as to its severity, etiology (somatic, visceral, or neuropathic), causation (directly from malignancy or from treatment side effects), and its impact on daily function. Treatments can include physical modalities, exercise, opioids, adjuvant medications, and interventional techniques. Barriers to treatment may include side effects, finances, and attitudes. New technologies in medication delivery systems, intrathecal pumps, injections, and surgery have greatly strengthened the armamentarium available to manage pain.
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Affiliation(s)
- Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
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