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Jebrouni F, Bailal H, Omari M, Khater K, Bali A, Al Jarroudi O, Brahmi SA, Afqir S. Management of Cisplatin-Induced Encephalopathy: A Case Report and Literature Review. Cureus 2024; 16:e62176. [PMID: 38993468 PMCID: PMC11239081 DOI: 10.7759/cureus.62176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Cisplatin is a cancer therapy drug commonly used. It is well-known for its antineoplastic properties, as well as for its numerous adverse effects, particularly its neurotoxicity. Symptoms associated with a central nervous system injury are unusual but can present a diagnostic challenge. Here, we report a case of a 62-year-old patient who was diagnosed with undifferentiated nasopharyngeal carcinoma. Cisplatin-based chemotherapy was administrated. Five days following the second cycle of treatment, the patient presented neurological disorders. A full biological workup and brain imaging were requested and revealed no abnormalities. The diagnosis of cisplatin encephalopathy was then suspected. Twenty days after cessation of cisplatin therapy, the neurological symptoms began to improve. Based on our case and a review of the literature, cisplatin-induced encephalopathy remains unusual. Its diagnosis is based on a combination of clinical, biological, and radiological criteria and requires the exclusion of other etiologies for neurological disorders in a patient being treated for cancer. Treatment is symptomatic and depends on stopping cisplatin therapy. These neurological adverse effects are often transitory and disappear without major repercussions.
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Affiliation(s)
| | - Hanan Bailal
- Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Mouhsine Omari
- Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Kaouthar Khater
- Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Asmae Bali
- Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | | | | | - Said Afqir
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
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2
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Salem Mahjoubi Y, Aouinti I, Charfi O, Zaiem A, Kaabi W, Lakhoua G, Daghfous R, El Aidli S. Neurotoxicity following atezolizumab in a patient with tolerated rechallenge. Therapie 2024; 79:393-396. [PMID: 37730448 DOI: 10.1016/j.therap.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Yasmine Salem Mahjoubi
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia.
| | - Imen Aouinti
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Ons Charfi
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Ahmed Zaiem
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Widd Kaabi
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Ghozlane Lakhoua
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Riadh Daghfous
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
| | - Sihem El Aidli
- National Center Chalbi Belkahia of Pharmacovigilance, 9, avenue du Dr Zouhaier Essafi, 1006 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine, Research unit: UR17ES12, 1006 Tunis, Tunisia
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3
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Ota S, Onimaru H, Izumizaki M. Effect of cisplatin on respiratory activity in neonatal rats. Pflugers Arch 2023; 475:233-248. [PMID: 36289078 DOI: 10.1007/s00424-022-02762-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/07/2022] [Accepted: 10/10/2022] [Indexed: 02/01/2023]
Abstract
One side effect of cisplatin, a cytotoxic platinum anticancer drug, is peripheral neuropathy; however, its central nervous system effects remain unclear. We monitored respiratory nerve activity from the C4 ventral root in brainstem and spinal cord preparations from neonatal rats (P0-3) to investigate its central effects. Bath application of 10-100 μM cisplatin for 15-20 min dose-dependently decreased the respiratory rate and increased the amplitude of C4 inspiratory activity. These effects were not reversed after washout. In separate perfusion experiments, cisplatin application to the medulla decreased the respiratory rate, and application to the spinal cord increased the C4 burst amplitude without changing the burst rate. Application of other platinum drugs, carboplatin or oxaliplatin, induced no change of respiratory activity. A membrane potential analysis of respiratory-related neurons in the rostral medulla showed that firing frequencies of action potentials in the burst phase tended to decrease during cisplatin application. In contrast, in inspiratory spinal motor neurons, cisplatin application increased the peak firing frequency of action potentials during the inspiratory burst phase. The increased burst amplitude and decreased respiratory frequency were partially antagonized by riluzole and picrotoxin, respectively. Taken together, cisplatin inhibited respiratory rhythm via medullary inhibitory system activation and enhanced inspiratory motor nerve activity by changing the firing property of motor neurons.
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Affiliation(s)
- Shinichiro Ota
- Department of Physiology, Showa University School of Medicine, Tokyo, 142-8555, Japan
| | - Hiroshi Onimaru
- Department of Physiology, Showa University School of Medicine, Tokyo, 142-8555, Japan.
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, Tokyo, 142-8555, Japan
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4
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Kaur G, Ashraf I, Peck MM, Maram R, Mohamed A, Ochoa Crespo D, Malik BH. Chemotherapy and Immunosuppressant Therapy-Induced Posterior Reversible Encephalopathy Syndrome. Cureus 2020; 12:e11163. [PMID: 33251070 PMCID: PMC7688184 DOI: 10.7759/cureus.11163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/25/2020] [Indexed: 11/25/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an entity which is characterized by acute to subacute onset of neurological symptoms like altered mental status, seizures, headaches and other focal neurological deficits. It is diagnosed with the help of MRI findings which typically involve the subcortical white matter of parieto-occipital lobes. In this review, we will discuss the various etiologies and risk factors including some of the most common chemotherapeutic agents and immunosuppressant agents associated with this disorder. We will discuss the mechanism of actions and side effect profiles of a few drugs and their role in causation of PRES. This review article discusses if there is any difference in presentation and imaging findings of PRES caused by cytotoxic agents versus caused by other etiologies. It also highlights the difficulty in management of PRES caused by cytotoxic agents as the discontinuation of these drugs could be life-threatening due to graft rejections or graft versus host disease.
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Affiliation(s)
- Gurleen Kaur
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ibtisam Ashraf
- Internal Medicine, Shalamar Institute of Health Sciences, Lahore, PAK
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mercedes Maria Peck
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ruchira Maram
- Internal Medicine, Arogyasri Healthcare Trust, Hyderabad, IND
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Alaa Mohamed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Memorial Hermann Texas Medical Center, Houston, USA
| | - Diego Ochoa Crespo
- Internal Medicine, Clinica San Martin, Azogues, ECU
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Xiromerisiou G, Kalampokini S, Rikos D, Provatas A, Tsouris Z, Markou K, Ralli S, Dardiotis E. Posterior reversible encephalopathy in a GT1a positive oculopharyngeal variant of Guillain-Barré syndrome: A case-report and review of the literature. Clin Neurol Neurosurg 2020; 196:106037. [DOI: 10.1016/j.clineuro.2020.106037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
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Gau YC, Wang HC, Hsiao HH, Liu YC. Gemcitabine/cisplatin/pembrolizumab-induced posterior reversible encephalopathy syndrome. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_6_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Di Genova L, Perruccio K, Celani MG, Mastrodicasa E, Cantisani TA, Esposito S, Caniglia M. Chemotherapy-Related Encephalopathy With Super-Refractory Status Epilepticus in a Child With Osteosarcoma: A Case Report With a Review of Literature. Front Pharmacol 2019; 10:963. [PMID: 31551775 PMCID: PMC6734028 DOI: 10.3389/fphar.2019.00963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/29/2019] [Indexed: 01/05/2023] Open
Abstract
Osteosarcoma is the most frequent primary cancer of the bones, and a combination of primary chemotherapy, surgery, and adjuvant chemotherapy is its current treatment. In adults, some authors have reported problems with memory and concentration following chemotherapy, but in children, severe neurologic dysfunction has been rarely reported. This report describes a 13-year-old patient with primary high-grade nonmetastatic osteosarcoma of the tibia who developed encephalopathy with super-refractory status epilepticus related to chemotherapy. He received methotrexate (MTX) and cisplatin (CDDP)-containing polychemotherapy, and after the first course of drug administration, he developed fever, confusion, a state of psychomotor agitation, and super-refractory status epilepticus with normal laboratory and imaging findings. The causal relationship between the administration of the first polychemotherapy course and his neurological manifestations may be supported by the evaluation and exclusion of other causes. The administration of antiepileptic drugs and off-label atypical antipsychotics was necessary to treat his neurological complications and behavioral changes. This patient represents the first known example of super-refractory status epilepticus in a child treated with MTX and CDDP-containing chemotherapy. Physicians should be aware that encephalopathy and seizures are possible consequences of CDDP therapy when administered alone or in combination with other chemotherapeutic agents. Further studies are needed to better define this relationship in children.
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Affiliation(s)
- Lorenza Di Genova
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Grazia Celani
- Neurophysiology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Mastrodicasa
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Maurizio Caniglia
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
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Makranz C, Khutsurauli S, Kalish Y, Eliahou R, Kadouri L, Gomori JM, Lossos A. Neurological variability in chemotherapy-induced posterior reversible encephalopathy syndrome associated with thrombotic microangiopathy: Case reports and literature review. Mol Clin Oncol 2017; 8:178-182. [PMID: 29387412 DOI: 10.3892/mco.2017.1476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/08/2017] [Indexed: 11/05/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by headaches, seizures, a confusional state and visual disturbances associated with transient predominantly bilateral posterior white mater magnetic resonance imaging lesions. It is primarily reported in the setting of hypertension, acute renal failure, peripartum eclampsia, autoimmune disease, immunosuppression and chemotherapy. Thrombotic microangiopathy (TMA), including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) has also been reported as potential PRES inducer. The present study reviews two cases of patients with PRES, associated with TMA caused by chemotherapy. Their clinical and imaging data, and the relevant literature were reviewed. Patient 1 presented with TMA-induced PRES following mitomycin-C for metastatic colon adenocarcinoma. Treatment with steroids, plasma exchange, intravenous immunoglobulins, aspirin, antihypertensive drugs, and diuretics resulted in resolution of the neurological and imaging deficits. Patient 2 presented with TMA-induced PRES following gemcitabine for metastatic breast carcinoma. Treatment was ineffective and the patient deteriorated despite verapamil, dexamethasone, and plasma exchange. In this report, the relevant literature regarding pathogenesis, treatment and prognosis of chemotherapy-induced PRES associated with TMA was reviewed. We conclude that several chemotherapy agents may cause PRES through various pathogenic mechanisms, leading to clinical variability and divergent response to therapy.
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Affiliation(s)
- Chen Makranz
- Department of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Salome Khutsurauli
- Department of Oncology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Yosef Kalish
- Department of Hematology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Ruth Eliahou
- Department of Radiology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Luna Kadouri
- Department of Oncology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - John Moshe Gomori
- Department of Radiology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Alexander Lossos
- Department of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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