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Lam L, Koopowitz S, Thompson A, Smith G, Tan S, Gupta A, Kovoor J, Harroud A, Bacchi S, Slee M. A systematic review of the symptomatic management of Lhermitte's phenomenon. J Clin Neurosci 2023; 116:32-36. [PMID: 37603922 DOI: 10.1016/j.jocn.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Lhermitte's phenomenon (LP) is a transient shock-like sensation that radiates down the spine into the extremities, usually with neck flexion. The potential efficacy and tolerability of various symptomatic therapies in the management of LP have not been systematically reviewed previously. METHOD A systematic review was conducted using PubMed, EMBASE, and the Cochrane Library from inception to August 2022 for peer-reviewed articles describing the treatment of patients with Lhermitte's phenomenon. The review adheres to the PRISMA guidelines and was registered on PROSPERO. RESULTS This systematic review included sixty-six articles, which included 450 patients with LP. Treatment of the underlying cause varied by aetiology. Whilst LP is most commonly considered in the context of structural pathology of the cervical cord, medication-induced LP was a common theme in the literature. The most common cause of medication-induced LP was platinum-based chemotherapy agents such as cisplatin and oxaliplatin. In medication-induced LP, symptoms typically resolved with cessation of the causative agent. Non-pharmacological treatment options were associated with mild-moderate symptomatic improvement. The most commonly used agents to treat patients with LP were carbamazepine and gabapentin, which resulted in variable degrees of symptomatic benefit. CONCLUSIONS No randomised studies currently exist to support the use of symptomatic therapies to treat LP. Observational data suggest that some therapies may yield a symptomatic benefit in the management of LP. However, this systematic review identified a significant paucity of evidence in the literature, which suggests that further controlled studies are needed to investigate the optimal management of this common neurologic phenomenon.
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Affiliation(s)
- Lydia Lam
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia.
| | | | | | - Georgia Smith
- Flinders University, Bedford Park, SA 5042, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia
| | - Adil Harroud
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Flinders University, Bedford Park, SA 5042, Australia
| | - Mark Slee
- Flinders University, Bedford Park, SA 5042, Australia
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Santos NAGD, Ferreira RS, Santos ACD. Overview of cisplatin-induced neurotoxicity and ototoxicity, and the protective agents. Food Chem Toxicol 2019; 136:111079. [PMID: 31891754 DOI: 10.1016/j.fct.2019.111079] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
Cisplatin has dramatically improved the survival rate of cancer patients, but it has also increased the prevalence of hearing and neurological deficits in this population. Cisplatin induces ototoxicity, peripheral (most prevalent) and central (rare) neurotoxicity. This review addresses the ototoxicity and the neurotoxicity associated with cisplatin-based chemotherapy, providing an integrated view of the potential protective agents that have been evaluated in vitro, in vivo and in clinical trials, their targets and mechanisms of protection and their effects on the antitumor activity of cisplatin. So far, the findings are insufficient to support the use of any oto- or neuroprotective agent before, during or after cisplatin chemotherapy. Despite their promising effects in vitro and in animal studies, many agents have not been evaluated in clinical trials. Additionally, the clinical trials have limitations concerning the sample size, controls, measurement, heterogeneous groups, several arms of treatment, short follow-up or no blinding. Besides that, for most agents, the effects on the antitumor activity of cisplatin have not been evaluated in tumor-bearing animals, which discourages clinical trials. Further well-designed randomized controlled clinical trials are necessary to definitely demonstrate the effectiveness of the oto- or neuroprotective agents proposed by animal and in vitro studies.
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Affiliation(s)
- Neife Aparecida Guinaim Dos Santos
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rafaela Scalco Ferreira
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonio Cardozo Dos Santos
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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O'Reilly A, Ryan S, MacEneaney P, O'Reilly SP, Cronin S, Power DG. Lhermitte's phenomenon and platinum, beware of latency. Oncol Res Treat 2014; 37:591-4. [PMID: 25342510 DOI: 10.1159/000365539] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lhermitte's sign (LS) is characterized by electric shock-like sensations, spreading along the spine in a cervico-caudal direction and into the arms and legs. It is felt upon flexion of the neck and reflects a myelopathy resulting from damage to sensory axons at the dorsal columns of the cervical spinal cord. In patients with cancer, LS can occur due to direct tumour involvement of the spine or in relation to radiotherapy. Chemotherapy-related LS has only rarely been reported. CASE REPORT We present the case of a 44-year-old patient treated with platinum- and etoposide-based chemotherapy for metastatic seminoma, who subsequently developed severe disabling LS. The severity and duration of LS in this case exceeds prior reports. We review the literature on chemotherapy-related LS and discuss the practice implications. CONCLUSION Neuropathy and LS related to cisplatin-based chemotherapy can result in significant adverse effects. Raised awareness of this complication could aid sub-phenotyping of the population most at risk and assist strategies to avert discomfort and disability post chemotherapy.
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Affiliation(s)
- Aine O'Reilly
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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Postma TJ, Heimans JJ. Neurological complications of chemotherapy to the peripheral nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:917-36. [PMID: 22230542 DOI: 10.1016/b978-0-444-53502-3.00032-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Affiliation(s)
- T J Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
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Earl HM, Connolly S, Latoufis C, Eagle K, Ash CM, Fowler C, Souhami RL. Long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas. Sarcoma 2011; 2:97-105. [PMID: 18521240 PMCID: PMC2395382 DOI: 10.1080/13577149878055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose. To study the long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas. Patients and Methods. Thirty-six adolescents and young adults (median age 17 years) were examined following chemotherapy for bone and soft tissue sarcomas. Twenty-nine (29/36) had received cisplatin (median
400 mg/m2), 15/36 ifosfamide (median 20 g/m2), and 12/36 vincristine (median 16 mg). Neurotoxicity
was assessed at a median of 8 months (range, 1–54 months) after completion of chemotherapy by clinical
examination, nerve conduction studies, audiograms and autonomic function tests. The same nerve conduction studies
were carried out in 20 normal volunteers to define normal ranges in this age group. Results. Sixteen patients (44%) had a significant reduction in deep tendon reflexes, and this
clinical parameter correlated well with abnormalities detected in nerve conduction studies. Vibration perception
threshold (VPT) was raised in 20/36 patients (55%) and this was the most sensitive single test in the assessment
of neuropathy. There was a significant
correlation between VPT and cumulative cisplatin dose received in mg/m-2
(r=0.607, p<0.01). Ten of 29 patients (35%) had abnormal nerve conduction
studies with a pattern characteristic of sensory axonal neuropathy. No patient complained of auditory symptoms, but
minor high tone hearing loss was detected by audiograms in 5/28 patients who had received cisplatin. No patients had
symptoms of autonomic neuropathy, but autonomic function tests showed minor abnormalities
in 4/22 patients tested, and all had received cisplatin. Conclusions. This study demonstrates significant, although asymptomatic, long-term neurotoxicity
of cisplatin in adolescents and young adults receiving chemotherapy for bone and soft tissue sarcomas. Follow-up
studies are planned to assess whether these neurological deficits improve with time.
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Affiliation(s)
- H M Earl
- Department of Oncology University of Cambridge School of Clinical Medicine Addenbrooke's Hospital Box 193, Hills Road Cambridge CB2 2QQ UK
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6
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Lhermitte's Sign Developing after IMRT for Head and Neck Cancer. Int J Otolaryngol 2010; 2010:907960. [PMID: 20628529 PMCID: PMC2902147 DOI: 10.1155/2010/907960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/09/2010] [Accepted: 05/07/2010] [Indexed: 11/18/2022] Open
Abstract
Background. Lhermitte's sign (LS) is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT) for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.
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Boland B, Mitcheson L, Wolff K. Lhermitte's sign, electric shock sensations and high dose ecstasy consumption: preliminary findings. J Psychopharmacol 2010; 24:213-20. [PMID: 19240087 DOI: 10.1177/0269881108100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to perform a preliminary investigation into the nature of electric shock-like experiences reported in association with the use of ecstasy tablets thought to contain methylenedioxymethamphetamines (MDMA). This included exploration of reports of electric shock-like experiences from the user's perspectives and identification of other variables that may be associated with their development. Furthermore we aimed to examine whether the well-recognised electric shock-like symptom, Lhermitte's sign (LS), is associated with ecstasy tablet use in some drug users. A single measure, cross-sectional survey was used incorporating mixed qualitative and quantitative methodology. A select group of ecstasy users (n = 35) recruited through a dance, music and lifestyle magazine completed a telephone interview. Lifetime prevalence of LS in the study population was 18% (n = 6). Development of LS was associated with use of more ecstasy tablets before a typical incident. This study indicates a relationship may exist between the use of ecstasy tablets and LS. The relationship may be dose dependent. The majority of the study population used other substances including alcohol when experiencing electrical shock sensations. LS may explain only a proportion of all electrical shock experiences among ecstasy users.
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Affiliation(s)
- B Boland
- Hertfordshire Partnership Foundation Trust, St Albans, Hertfordshire, UK.
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Gemici C. Lhermitte's sign: Review with special emphasis in oncology practice. Crit Rev Oncol Hematol 2009; 74:79-86. [PMID: 19493683 DOI: 10.1016/j.critrevonc.2009.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/03/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022] Open
Abstract
Lhermitte's sign (LS) is characterized by electric shock like sensation, spreading along the spine in a cervico-caudal direction and also into both arms and legs, which is felt upon forward flexion of the neck. It is a myelopathy resulting from damage to sensory axons at the dorsal columns of the cervical or thoracic spinal cord and a well-known clinical sign in neurology practice. Patients with cancer may present with LS due to various causes either related to the tumor itself or to its treatment. Spinal cord tumors, radiotherapy and chemotherapy are possible causes of LS observed in oncology practice. While LS is observed with a frequency of 3.6-13% in large patient groups receiving radiotherapy for head and neck and thoracic malignancies, the true incidence of chemotherapy and spinal cord tumor induced LS is unknown with only few reported cases in the literature. In the present article, various pathologies causing Lhermitte's sign are reviewed with special emphasis on the implications of this sign in oncology practice.
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Affiliation(s)
- Cengiz Gemici
- Dr. Lutfi Kirdar Kartal Education and Research Hospital, Department of Oncology, Umraniye, Istanbul, Turkey.
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9
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Jurado JM, Pajares B, Olmos D, Sevilla I, Alba E. 'Out of blue' Lhermitte's sign: three cases due to low cumulative doses of oxaliplatin. Ann Oncol 2008; 19:2093-4. [PMID: 18977850 DOI: 10.1093/annonc/mdn684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Verstappen CCP, Heimans JJ, Hoekman K, Postma TJ. Neurotoxic complications of chemotherapy in patients with cancer: clinical signs and optimal management. Drugs 2003; 63:1549-63. [PMID: 12887262 DOI: 10.2165/00003495-200363150-00003] [Citation(s) in RCA: 288] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Since bone marrow toxicity, as the major limiting factor in most chemotherapeutic regimens, can be overcome with growth factors or bone marrow transplantation, the use of higher doses of chemotherapy is possible, which increases the risk of neurotoxicity. Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma. In this article we describe the neurological adverse effects of the most commonly used chemotherapeutic agents. The vinca-alkaloids, cisplatin and the taxanes are amongst the most important drugs inducing peripheral neurotoxicity. These drugs are widely used for various malignancies such as ovarian and breast cancer, and haematological cancers. Chemotherapy-induced neuropathy is clearly related to cumulative dose or dose-intensities. Patients who already have neuropathic symptoms due to diabetes mellitus, hereditary neuropathies or earlier treatment with neurotoxic chemotherapy are thought to be more vulnerable for the development of chemotherapy-induced peripheral neuropathy. Methotrexate, cytarabine (cytosine arabinoside) and ifosfamide are primarily known for their central neurotoxic side effects. Central neurotoxicity ranges from acute toxicity such as aseptic meningitis, to delayed toxicities comprising cognitive deficits, hemiparesis, aphasia and progressive dementia. Risk factors are high doses, frequent administration and radiotherapy preceding methotrexate chemotherapy, which appears to be more neurotoxic than methotrexate as single modality. Data on management and neuroprotective agents are discussed. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the neuroprotective agents described in this article can be recommended for standard use in daily practise at this moment, and further studies are needed to confirm some of the beneficial effects described.
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Affiliation(s)
- Carla C P Verstappen
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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11
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Abstract
Since the introduction of platinum-based combination chemotherapy, particularly cisplatin, the outcome of the treatment of many solid tumours has changed. The leading platinum compounds in cancer chemotherapy are cisplatin, carboplatin and oxaliplatin. They share some structural similarities; however, there are marked differences between them in therapeutic use, pharmacokinetics and adverse effects profiles [1-4]. Compared to cisplatin, carboplatin has inferior efficacy in germ-cell tumour, head and neck cancer and bladder and oesophageal carcinoma, whereas both drugs seem to have comparable efficacy in advanced non-small cell and small cell lung cancer as well as ovarian cancer [5-7]. Oxaliplatin belongs to the group of diaminocyclohexane platinum compounds. It is the first platinum-based drug that has marked efficacy in colorectal cancer when given in combination with 5-fluorouracil and folinic acid [8,9]. Other platinum compounds such as oral JM216, ZD0473, BBR3464 and SPI-77, which is a pegylated liposomal formulation of cisplatin, are still under investigation [10-13], whereas nedaplatin has been approved in Japan for the treatment of non-small cell lung cancer and other solid tumours. This review focuses on cisplatin, carboplatin and oxaliplatin.
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Affiliation(s)
- Jörg Thomas Hartmann
- Department of Hematology, Oncology, Immunology, Rheumatology, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany.
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12
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Ciucci G, De Giorgi U, Leoni M, Bianchedi G. Lhermitte's sign following oxaliplatin-containing chemotherapy in a cisplatin-pretreated ovarian cancer patient. Eur J Neurol 2003; 10:328-9. [PMID: 12752412 DOI: 10.1046/j.1468-1331.2003.00579.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Esik O, Csere T, Stefanits K, Lengyel Z, Sáfrány G, Vönöczky K, Lengyel E, Nemeskéri C, Repa I, Trón L. A review on radiogenic Lhermitte's sign. Pathol Oncol Res 2003; 9:115-20. [PMID: 12858217 DOI: 10.1007/bf03033755] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2003] [Accepted: 05/05/2003] [Indexed: 10/20/2022]
Abstract
Radiation myelopathy is a rare, but extremely serious side-effect of radiotherapy. Recovery from radiation-induced motor sequelae is rare, whereas, the regeneration of sensory losses is relatively frequent. Among the sensory radiogenic injuries of the spinal cord, Lhermitte's sign (LS) is most frequent. This review describes the clinical picture and diagnostic imaging signs of radiogenic LS. There have been only a few studies on large patient groups with radiogenic LS, demonstrating a rate of occurrence of 3.6-13%, relating mainly to mantle irradiation or the radiotherapy of head and neck tumors. These cases typically manifest themselves 3 months following radiotherapy and gradually disappear within 6 months. Only 3 LS cases have been described in the English literature with extraordinarily severe symptoms lasting for more than 1 year. MRI, a sensitive tool in the detection of demyelination, failed to reveal any pathological sign accompanying radiogenic LS. However, positron emission tomography demonstrated increased [18F]fluorodeoxyglucose accumulation and [15O]butanol perfusion, but a negligible [11C]methionine uptake in the irradiated spinal cord segments in patients with long-standing LS. These imaging data are suggestive of a close direct relationship between the regional perfusion and metabolism of the spinal cord, very much like the situation in the brain. We postulate that an altered, energy-demanding conduction along the demyelinated axons of patients with chronic radiogenic LS may explain the increased metabolism and perfusion.
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Affiliation(s)
- Olga Esik
- Department of Oncotherapy, Semmelweis University, H-1122 Budapest, Hungary.
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Taieb S, Trillet-Lenoir V, Rambaud L, Descos L, Freyer G. Lhermitte sign and urinary retention: atypical presentation of oxaliplatin neurotoxicity in four patients. Cancer 2002; 94:2434-40. [PMID: 12015768 DOI: 10.1002/cncr.10500] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Regimens combining oxaliplatin with fluorouracil and folinic acid are standard therapeutic options for patients with metastatic colorectal carcinoma. Oxaliplatin has a good safety profile, although it is responsible for dose-limiting neurotoxicity typically consisting of two distinct clusters of symptoms. Cold-induced distal paresthesiae occur during or shortly after infusion in most patients and are usually transient and mild. A persistent sensory peripheral neuropathy may develop with prolonged treatment, eventually causing superficial and deep sensory loss, sensory ataxia and functional impairment. METHODS The authors report four cases of atypical neurotoxicity induced by oxaliplatin in patients treated for metastatic colorectal carcinoma. Two patients were male and two were female, with an age range of 52-59 years. RESULTS Three patients experienced Lhermitte sign and two experienced urinary retention. In all cases, the cumulative dose of oxaliplatin was higher than 1000 mg (range, 1248-2040 mg). Brain and spinal magnetic resonance imaging was performed in two patients and was normal. Somatosensory evoked potentials were recorded in two patients and suggested cervical dorsal column dysfunction. Symptoms resolved a few weeks after discontinuation of oxaliplatin. CONCLUSIONS Lhermitte sign may be induced via a neurotoxic effect on the ascending axons of these T-shaped neurons. An atonic bladder may be the result of damage to the sensory portion of the sacral reflex arc, either in the dorsal roots, as for example in diabetic neuropathy, or in the posterior columns, as in tabes dorsalis. Alternatively, it may result from a paralysis of the parasympathetic fibers that control the bladder musculature. It is unclear at present whether the micturition difficulties observed in patients in the current series are due to sensory neuropathy or to autonomic neuropathy, event if the former hypothesis seems more likely, as autonomic neuropathy has not been previously observed with oxaliplatin, and its association with cisplatin is exceedingly rare and controversial.
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Affiliation(s)
- Sarah Taieb
- Medical Oncology Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Abstract
Sensory neuronopathy (SN) presents with sensory ataxia and no weakness. The site of pathology is in the dorsal root ganglia. Electrodiagnostic studies show absence of sensory nerve action potentials and preservation of motor nerve function. Elderly individuals with sensory ataxia and typical electrodiagnostic findings of SN should be evaluated for underlying carcinoma.
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Affiliation(s)
- R Pourmand
- Department of Neurology, Indiana University School of Medicine, Indianapolis, USA
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16
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Maisonobe T, Le Forestier N, Bouche P. [Electrophysiologic study, diagnosis and cases of acquired sensory polyneuropathy]. Neurophysiol Clin 1996; 26:202-15. [PMID: 8975110 DOI: 10.1016/s0987-7053(96)85002-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Sensory neuropathies encompass a group of neuropathies affecting solely or predominantly peripheral sensory nerves. They are rarely encountered in clinical practice. The authors review sensory nerve conduction studies and compare the various recording technics. Values of compound sensory action potential amplitude and sensory nerve conduction velocity are analyzed. On the basis of clinical and electrophysiological sensory impairment, three types of neuropathies can be proposed: neuropathies with either large, small or total myelinated fibers involvement. Lastly definable causes of sensory neuropathies are reviewed.
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Affiliation(s)
- T Maisonobe
- Service d'explorations fonctionnelles, neurologie, hôpital de la Satpetricre, Paris
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Abstract
We describe a previously healthy 29 year-old man who developed Lhermitte's sign, a shock-like or electric sensation, transmitted down the spine, which occurred during neck flexion or rotation. Evaluation demonstrated an intrinsic, fusiform mass extending from c5 to c7. At operation, the mass was completely removed and found to be a low-grade ependymoma. The sensory phenomena of Lhermitte's sign were most likely caused by tumor-induced distortion and demyelination of cervical dorsal column sensory axons. Lhermitte's sign is most prevalent in patients with multiple sclerosis, cervical spondylotic myelopathy, cisplatin neurotoxicity, cervical radiation injury, and neck trauma. Rarely, Lhermitte's sign occurs with spinal cord compression from epidural or subdural tumor. This patients is the first reported case of an intrinsic spinal cord tumor to present with Lhermitte's sign.
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Affiliation(s)
- H B Newton
- Department of Neurology, Ohio State University Hospitals, Columbus, USA
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Lossos A, Siegal T. Electric shock-like sensations in 42 cancer patients: clinical characteristics and distinct etiologies. J Neurooncol 1996; 29:175-81. [PMID: 8858523 DOI: 10.1007/bf00182141] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We retrospectively evaluated 42 consecutive cancer patients manifesting electric shock-like sensations. Fourty three percent presented with Lhermitte's sign (LS), 24% with the previously described outstretching ir. abduction maneuver (OAM) of the arms, and 33% had both phenomena. Twenty nine patients had underlying polyneuropathy related to cisplatin-based chemotherapy in 27 and to thiamine deficiency in 2. Thirtreen patients had myelopathy which was induced by radiotherapy in 11. Patients with polyneuropathy manifested both LS and OAM, while patients with myelopathy more often presented with LS. Neurologic signs suggestive of spinal cord involvement were present in 3 patients with polyneuropathy and in 7 of 11 irradiated patients. MRI disclosed cervical spinal cord swelling in 3 patients with LS. Prolonged cervical latencies on SSER were noted in 5 of 15 patients. All had LS and 3 also had OAM associated with abnormal latencies in the brachial plexi. We conclude that LS and OAM are positive sensory manifestations of increased mechanosensitivity of the damaged central or peripheral sensory axons in the cervico-brachial area. In cancer patients, these phenomena largely manifest treatment-induced myelopathy or polyneuropathy. Auxillary studies help to confirm diagnosis and to depict the uncommon but treatable causes.
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Affiliation(s)
- A Lossos
- Department of Neurology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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19
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Affiliation(s)
- M K Tuxen
- Department of Oncology, Herlev University Hospital, Denmark
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20
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Bogliun G, Marzorati L, Cavaletti G, Frattola L. Evaluation by somatosensory evoked potentials of the neurotoxicity of cisplatin alone or in combination with glutathione. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1992; 13:643-7. [PMID: 1336008 DOI: 10.1007/bf02334967] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of high doses of cisplatin (DDP) in the treatment of different solid tumors is often prevented by the onset of a disabling sensory neuropathy. In an attempt to minimize DDP-induced neurotoxicity different schedules of DDP administration have been tested. Moreover, during the past few years some putative neuroprotective drugs have been reported as reducing DDP neurotoxicity. In this prospective, randomized study we evaluated in a series of 33 patients affected by relapsing ovarian cancer the effect on the sensory pathway of a non-conventional schedule of DDP administration as monochemiotherapy or in combination with one of the neuroprotective drugs (i.e. glutathione). The results of the neurophysiologic examinations performed before and immediately after chemotherapy suggest that these schedules besides being safe and effective in the treatment of the ovarian cancer, have an extremely low peripheral neurotoxicity.
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Affiliation(s)
- G Bogliun
- Clinica Neurologica, Università di Milano
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Sminia P, Los G, Hendriks JJ, van Vugt MJ, Haveman J, González González D. The influence of hyperthermia on the uptake of cisplatin in the rat cervical spinal cord. Eur J Cancer 1992; 28A:1139-43. [PMID: 1627385 DOI: 10.1016/0959-8049(92)90474-g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The influence of local hyperthermia on the uptake of cisplatin in the rat cervical spinal cord was investigated. After single intraperitoneal or intravenous injection of cisplatin (5 mg/kg body weight), the spinal cord region cervical 5-thoracic 2 was heated for 60 min at mean (S.D.) 41.2 (0.4) degrees C or 40 min 42.4 (0.3) degrees C using a 434 MHz microwave heating device. One day after treatment with either hyperthermia alone, cisplatin alone or the combination, none of the animals expressed neurological symptoms. The spinal cord was dissected and platinum levels were measured by flameless atomic absorption spectroscopy. No difference was found in uptake of platinum in the spinal cord between control- and heat treated animals. In a second series of experiments, the spinal cord was heated for 30-60 min. during a 2 h infusion of cisplatin. One day after treatment at 42.3 degrees C for 60 min, neither motor nor sensory functions were affected and platinum levels did not differ significantly between control and treated animals. Also, platinum levels measured in the spinal cord immediately after cisplatin infusion were not influenced by heat treatment at 42.1 or 43.0 degrees C for 30 min. However, after a heat dose of 60 min 43 degrees C, cisplatin uptake was significantly increased (P less than 0.001) by a factor of 2.8 (1.3). The data demonstrate that mild hyperthermia has no effect on the uptake of cisplatin in the spinal cord, while an injurious heat dose leads to a significant increase in cisplatin uptake. The present findings indicate that, in case of treatment of tumours of the central nervous system with hyperthermia and cisplatin, a treatment which might be toxic for the tumour is well tolerated by the normal nervous tissue.
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Affiliation(s)
- P Sminia
- Department of Radiotherapy, Academisch Medisch Centrum, University of Amsterdam, The Netherlands
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22
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LoMonaco M, Milone M, Batocchi AP, Padua L, Restuccia D, Tonali P. Cisplatin neuropathy: clinical course and neurophysiological findings. J Neurol 1992; 239:199-204. [PMID: 1317914 DOI: 10.1007/bf00839140] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sixteen patients treated with cisplatin (CDDP) 40 mg/m2 on days 1-5 every 4 weeks for three courses (cumulative dose 600 mg/m2) were clinically and neurophysiologically tested before, during and 1, 3, 6, 9 and 12 months after CDDP administration. The first symptoms of polyneuropathy occurred in 4 of 9 patients after the second course (cumulative dose 400 mg/m2). One month after treatment 1 of 9 patients was asymptomatic, 5 complained of symptoms and 3 showed clinical and neurophysiological signs of polyneuropathy. Three months after CDDP all patients were affected. Clinical and neurophysiological signs of severity progression were noted up to 6 months after treatment with CDDP.
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Affiliation(s)
- M LoMonaco
- Institute of Neurology, Università Cattolica S. Cuore, Rome, Italy
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23
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Cavaletti G, Marzorati L, Bogliun G, Colombo N, Marzola M, Pittelli MR, Tredici G. Cisplatin-induced peripheral neurotoxicity is dependent on total-dose intensity and single-dose intensity. Cancer 1992; 69:203-7. [PMID: 1309303 DOI: 10.1002/1097-0142(19920101)69:1<203::aid-cncr2820690133>3.0.co;2-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors prospectively evaluated the effects of three different schedules of cisplatin (DDP) administration in 60 patients with advanced epithelial ovarian cancer. The individual total dose of DDP was 450 mg/m2 in all three groups, and the anti-cancer response at the end of treatment was similar for the different regimens. The clinical and neurophysiologic results confirmed that axonal sensory neuropathy occurred after the standard administration of DDP (75 mg/m2 in 3-week cycles) and probably not only the peripheral, but also the central sensory pathway, was involved. Although the total dose of the drug was identical, the two less conventional schedules were less neurotoxic. These results suggest that not only the total-dose intensity, but also the single-dose intensity are relevant in the onset of DDP-induced sensory neuropathy; therefore, the use of less neurotoxic schedules may prevent or reduce sensory nerve damage.
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Affiliation(s)
- G Cavaletti
- Neurologic Clinic, S. Gerardo Hospital, University of Milan, Italy
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24
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Ventafridda V, Caraceni A, Martini C, Sbanotto A, De Conno F. On the significance of Lhermitte's sign in oncology. J Neurooncol 1991; 10:133-7. [PMID: 1895161 DOI: 10.1007/bf00146874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present three cases of Lhermitte's sign out of twenty consecutive cases of epidural spinal cord compression due to metastatic cancer. The three patients were diagnosed with epidural thoracic compressions. The literature on Lhermitte's sign is reviewed with emphasis on the differential diagnosis of this symptom in oncological patients.
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Affiliation(s)
- V Ventafridda
- Pain Therapy and Palliative Care Division, National Cancer Institute of Milan, Italy
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25
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Boogerd W, ten Bokkel Huinink WW, Dalesio O, Hoppenbrouwers WJ, van der Sande JJ. Cisplatin induced neuropathy: central, peripheral and autonomic nerve involvement. J Neurooncol 1990; 9:255-63. [PMID: 2128320 DOI: 10.1007/bf02341156] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A prospective study was performed in patients treated with cisplatin to evaluate the occurrence and degree of central, peripheral and autonomic neuropathy and to determine the most accurate method to study this neuropathy. Twelve patients were examined before, during and after treatment. Evaluation included neurologic examination, conventional nerve conduction studies of the median and peroneal nerves and short latency somatosensory evoked potentials (SSER) after median and tibial nerve stimulation. Valsalva maneuvers before and during treatment were performed in 11 patients. Symptoms of peripheral neuropathy paralleled clinical signs. Conventional nerve conduction studies did not seem to be more accurate than clinical examination in determining peripheral neuropathy. SSER appeared to be the most sensitive method for the detection of peripheral nerve impairment. A slowing of central conduction velocity occurred after cumulative doses of 200-400 mg/m2 as measured by SSER. In two patients also some involvement of the autonomic nerves was suggested.
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Affiliation(s)
- W Boogerd
- Clinical Division of the Netherlands Cancer Institute (Antonie van Leeuwenhoekziekenhuis), Amsterdam
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26
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Abstract
Forty-five patients with cisplatin-induced peripheral neuropathy (PN) were evaluated retrospectively after treatment with cumulative doses of cisplatin ranging from 201 to 1952 mg/m2. The patients were followed for up to 23 months (median, 4.5 months), and 32 of them were evaluated more than once. Severity of symptoms was related to higher cumulative doses of cisplatin but with marked individual variability. Off-therapy deterioration of the PN continued in 14 patients (31%) for 2.5 to 5.5 months after withdrawal of cisplatin, and only four patients showed some improvement during the follow-up period. Symptomatic deterioration often was heralded by new onset of muscle cramps (with normal Ca2+/Mg2+ levels) and/or by manifestations of probable spinal dorsal column and/or nerve root demyelinating syndromes presenting as either Lhermitte's sign and/or as an electric-shock sensation along the upper extremities when outstretched in 90 degrees shoulder abduction. Cramps and demyelinating syndromes were each noted in 31% of the patients. Muscle cramps tended to resolve several months after withdrawal of therapy, and demyelinating syndromes were always transient (1.5 to 6.0 months) and did not progress despite ongoing therapy in five patients. Our study indicates that, after withdrawal of therapy, patients with cisplatin-induced PN may continue to deteriorate for several months. Manifestations of muscle cramps and demyelinating syndromes signify a worsening course of the PN but should not automatically indicate interruption of therapy.
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Affiliation(s)
- T Siegal
- Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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27
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Sebille A, St-Guily JL, Angelard B, de Stabenrath A. Low prevalence of cisplatin-induced neuropathy after 4-day continuous infusion in head and neck cancer. Cancer 1990; 65:2644-7. [PMID: 2160314 DOI: 10.1002/1097-0142(19900615)65:12<2644::aid-cncr2820651208>3.0.co;2-f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The toxicity of cisplatin on peripheral nerves was studied using electrophysiologic recordings in 52 patients with head and neck squamous cell carcinoma. Induction chemotherapy (cisplatin: 25 mg/m2/day, days 1-4; 5-fluorouracil: 1 g/m2/day, days 1-4) was administered by continuous infusion every 3 weeks. Electrophysiologic recordings were performed before and after the completion of three courses of chemotherapy (cisplatin total dose: 250-300 mg/m2). The comparison between the recordings showed 14% of the patients had an increase in the latency of the soleus muscle monosynaptic reflex as studied by the Hoffman reflex and 9% showed a decrease in the conduction velocity of the cutaneous sensory fibers of the median nerve. These results indicated a low prevalence of cisplatin-induced neuropathy. The respective roles played by the continuous infusion of the drug and by the potentiation of neurotoxic effects resulting from the association of cisplatin with other neurotoxins is discussed to explain this low toxicity.
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Affiliation(s)
- A Sebille
- Laboratoire d'Electrophysiologie Fonctionnelle, Faculté de Medecine, Paris, France
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28
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Affiliation(s)
- R J Cersosimo
- Northeastern University College of Pharmacy and Allied Health Professions, Boston, MA
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29
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Terheggen PM, van der Hoop RG, Floot BG, Gispen WH. Cellular distribution of cis-diamminedichloroplatinum(II)-DNA binding in rat dorsal root spinal ganglia: effect of the neuroprotecting peptide ORG.2766. Toxicol Appl Pharmacol 1989; 99:334-43. [PMID: 2544043 DOI: 10.1016/0041-008x(89)90015-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The in situ binding of the anticancer drug cis-diamminedichloroplatinum(II) (cisDDP) to DNA was studied in the rat dorsal root spinal ganglion (DRG), using an antiserum against cisDDP-modified calf thymus DNA in a quantitative immunocytochemical assay. Rats received a dose of cisDDP (1 mg/kg), two times a week, up to a cumulative dose of 15 mg/kg (group I) or 34 mg/kg (group II). Rats of group III were given a single dose of 15 mg/kg. Rats were killed 48 hr (groups I and II) or 6 hr (group III) after the last injection. In groups I and II cisDDP-induced neurological damage was assessed by measuring both motor and sensory nerve conduction velocities (MNCV and SNCV). Whereas the MNCV was not influenced by the treatment with cisDDP, the SNCV decreased significantly. The level of cis-DDP-DNA binding in DRG satellite cells equalled that in liver cells, but binding could not be shown in DRG neuron nuclei. The level of cisDDP-DNA binding in spinal cord and brain was very low. The neuroprotecting peptide ORG.2766, an ACTH4-9 analog, was given sc (10 micrograms/rat) four times a week concomitantly with cisDDP to some rats of groups I and II. ORG.2766 prevented the decrease of the SNCV, but did not change the extent of cisDDP-DNA binding in satellite or liver cells. It is concluded that the amelioration of cisDDP toxicity by ORG.2766 is not directly related to the cisDDP-DNA binding in satellite cells.
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Affiliation(s)
- P M Terheggen
- Division of Chemical Carcinogenesis, The Netherlands Cancer Institute, Amsterdam
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30
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Kaasa S, Olsnes BT, Mastekaasa A. Neuropsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy or radiotherapy. Acta Oncol 1988; 27:241-6. [PMID: 3415853 DOI: 10.3109/02841868809093532] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neuropsychological tests were used to evaluate possible central nervous system dysfunction in patients treated with chemotherapy. Ninety-five patients with non-small cell lung cancer limited disease were randomized to either radiotherapy (2.8 Gy x 15) or combination chemotherapy with cisplatin and etoposide. In order to evaluate cognitive functions three neuropsychological tests were applied: Trail Making, Benton Visual Retention Test and Verbal Learning. Changes in the patients' test scores before and after treatment were compared. The chemotherapy patients showed reduced performance on some of the neuropsychological tests compared to the radiotherapy group. This indicates a treatment related effect on the central nervous system, possibly caused by the combination chemotherapy.
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Affiliation(s)
- S Kaasa
- Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Oslo
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31
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Riggs JE, Ashraf M, Snyder RD, Gutmann L. Prospective nerve conduction studies in cisplatin therapy. Ann Neurol 1988; 23:92-4. [PMID: 3345071 DOI: 10.1002/ana.410230116] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We studied nerve conduction prospectively in 38 women receiving cisplatin for gynecological malignancies. Decreased sensory nerve action potential amplitudes and prolonged sensory latencies were the only significant changes identified. This prospective electrophysiological study validates the clinical observation of frequent sensory symptoms and occasional sensory neuropathies associated with cisplatin therapy.
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Affiliation(s)
- J E Riggs
- Department of Neurology, West Virginia University School of Medicine, Morgantown
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32
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Daugaard GK, Petrera J, Trojaborg W. Electrophysiological study of the peripheral and central neurotoxic effect of cis-platin. Acta Neurol Scand 1987; 76:86-93. [PMID: 3673502 DOI: 10.1111/j.1600-0404.1987.tb03551.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We describe clinical and electrophysiological findings in 8 patients with tumors of germ cell origin before and after treatment with high-dose cisplatin (800-1400 mg) combined with etoposide and bleomycin. All patients developed clinical or electrophysiological signs, or both, of a peripheral sensory neuropathy. One had in addition clinical and electrophysiological signs of CNS involvement, and 2 had a central conduction defect revealed by auditory stimulation.
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Affiliation(s)
- G K Daugaard
- Department of Oncology, Finsen Institute, Copenhagen, Denmark
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