Neuromuscular complications of cancer

Electrodiagnosis in Cancer Rehabilitation

With numerous advancements in early detection and multimodal therapy, cancer has become a chronic disease. As the number of cancer survivors continues to increase, physiatrists and other neuromuscular disease specialists are more likely to encounter individuals with residual impairments, disabilities, and/or handicaps resulting from cancer or related treatments. The patient with cancer is especially prone to injury directed at the peripheral nervous system at multiple anatomic levels. Electrodiagnosis is an invaluable tool in the evaluation of neuromuscular disorders in this patient population.

Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies

Objective

To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology.

Method

We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records.

Results

We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases.

Conclusion

By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.

Neurologic complications of cancer chemotherapy

Neurotoxicity related to cancer therapy is a common problem in oncology practice. Neurologic side effects can be dose-limiting, can inhibit treatment, and can substantially diminish quality of life. Symptoms may appear acutely after treatment, or remotely after therapy has been discontinued. Multiple therapies may share similar toxicities, and certain agents may potentiate symptoms. When faced with the development of neurologic complaints, familiarity with the most common complications is helpful in determining the etiology of these symptoms. This review will discuss the common complications of both established and novel agents used to treat cancer.

Paraneoplastic mononeuritis multiplex in non-small-cell lung carcinoma

A 60-year-old man developed two selective peripheral mononeuropathies of the peroneal and later the radial nerve, shortly after a diagnosis of large-cell lung carcinoma. Nerve conduction studies and electromyography confirmed isolated lesions in both nerves, and in the case of the peroneal nerve lesion, focal conduction block was localised to the level of the fibula neck. Subsequent magnetic resonance imaging of the lower limb excluded focal compression or malignant infiltration along the course of the peroneal nerve, and there was no signal change within the nerve, prompting a diagnosis of paraneoplastic mononeuritis multiplex. Anti-neuronal antibodies and serological markers of systemic vasculitis were negative. Neither the patient's large-cell lung carcinoma nor mononeuritis multiplex responded to chemotherapy, and he died within 6 months of the initial diagnosis.

Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 3. Cancer Rehabilitation

This self-directed learning module highlights the treatment and rehabilitation of patients with cancer. It is part of the study guide on cardiac, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article reviews medical and rehabilitation issues in patients with various types of cancer. Cases were selected to allow discussion of problems seen in both younger and older patient populations. Identification of common sequelae of cancer and cancer treatments, associated rehabilitation challenges, and appropriate interventions are included.

OVERALL ARTICLE OBJECTIVE

To summarize the medical and rehabilitation issues in patients with various types of cancer.

Neurologic Complications of Plasma Cell Disorders

Plasma cell disorders are associated with a wide spectrum of neurologic complications that predominantly involve the peripheral nervous system. Distinct clinical syndromes have been recognized, and antibodies to several glycoproteins of the peripheral nervous system have been identified. The main clinical, laboratory, immunologic, and pathologic features of neurologic complications that occur in patients with monoclonal gammopathies of unknown significance, multiple myeloma, plasmacytoma, plasma cell leukemia, Waldenstrom's macroglobulinemia, and immunoglobulin-related amyloidosis are summarized in this review. Knowledge of the pathogenesis in this group of disorders has increased in recent years, allowing better diagnosis and treatment.

Neurologic complications of solid tumors

This article reviews the neurologic complications of the most common solid tumors, including lung, breast, gastrointestinal, genitourinary, gynecologic, head and neck cancers, melanoma and sarcomas. As systemic therapy improves for many of these tumors, patients are surviving longer and the incidence of neurologic complications is increasing.