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JAMA Oncology May 2019
Topics: Antineoplastic Agents; Humans; Neuralgia; Peripheral Nervous System Diseases
PubMed: 30816956
DOI: 10.1001/jamaoncol.2018.6771 -
Continuum (Minneapolis, Minn.) Oct 2014Monoclonal gammopathies are common in the general population and occur in 10% of patients with peripheral neuropathy. It is important for the clinician to be able to... (Review)
Review
PURPOSE OF REVIEW
Monoclonal gammopathies are common in the general population and occur in 10% of patients with peripheral neuropathy. It is important for the clinician to be able to determine whether an association exists between the paraprotein and the neuropathy. The clinical phenotype of the neuropathy, as well as the type of monoclonal protein, provides clues for the diagnosis. Optimal management of paraproteinemic neuropathies requires appropriate evaluation of the monoclonal protein for an underlying hematologic disorder.
RECENT FINDINGS
Clinical studies in paraproteinemic neuropathies have provided a better understanding of these disorders, but much is still unknown regarding the pathophysiologic mechanisms. Recent clinical trials in immunoglobulin M (IgM) neuropathy have shown that better outcome measures and treatment approaches are needed. Peripheral blood stem cell transplantation has shown promising improvements in the treatment of polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) syndrome and immunoglobulin light chain (AL) amyloidosis.
SUMMARY
Recognizing the frequent association of neuropathy with monoclonal proteins and evaluating for a hematologic malignancy should enable physicians to find better treatments and ultimately improve neuropathy outcome.
Topics: Aged; Disease Management; Female; Humans; Male; Middle Aged; Paraproteinemias; Peripheral Nervous System Diseases
PubMed: 25299284
DOI: 10.1212/01.CON.0000455879.99050.26 -
JAMA Network Open Mar 2020This randomized clinical trial investigates the effect of acupuncture vs a sham procedure or usual care for chemotherapy-induced peripheral neuropathy symptoms. (Randomized Controlled Trial)
Randomized Controlled Trial
This randomized clinical trial investigates the effect of acupuncture vs a sham procedure or usual care for chemotherapy-induced peripheral neuropathy symptoms.
Topics: Acupuncture Therapy; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasms; Peripheral Nervous System Diseases; Treatment Outcome
PubMed: 32159808
DOI: 10.1001/jamanetworkopen.2020.0681 -
Neurotoxicology Dec 2020Vincristine (VCR), an alkaloid extracted from vinca, is often used in combination with other chemotherapeutic drugs to treat a variety of cancers, such as acute... (Review)
Review
Vincristine (VCR), an alkaloid extracted from vinca, is often used in combination with other chemotherapeutic drugs to treat a variety of cancers, such as acute lymphoblastic leukaemia (ALL), malignant lymphoma, and neuroblastoma. However, VCR possesses dose-dependent neurotoxicity, which is the main factor restricting its application. Vincristine-induced peripheral neuropathy (VIPN) not only limits the dose of VCR and leads to the discontinuation of treatment but also triggers serious damage to the physical and mental health of patients. In addition, VIPN brings huge healthcare costs to patients and society. Individuals with VIPN often exhibit mechanical allodynia, sensory/tactile disorders, and numbness in the hands and feet. Unfortunately, VIPN is easily ignored due to its variable symptoms, which gives rise to insufficient research on the aetiology and pathogenesis of this disease, thereby resulting in a lack of appropriate preventive and therapeutic management. We performed a comprehensive review of the latest findings on VIPN in terms of symptoms, risk factors, potential mechanisms, and prevention and treatment measures. The purpose was to help clinicians better understand and accurately diagnose VIPN, select appropriate intervention measures and reduce the damage to cancer patients.
Topics: Animals; Antineoplastic Agents, Phytogenic; Humans; Neurotoxicity Syndromes; Peripheral Nerves; Peripheral Nervous System Diseases; Risk Assessment; Risk Factors; Vincristine
PubMed: 33053366
DOI: 10.1016/j.neuro.2020.10.004 -
Neurological Sciences : Official... Oct 2020Peripheral neuropathy (PN) is a common neurological problem defined as a dysfunction of sensory, motor, and autonomic nerves. The presence of peripheral neuropathy has... (Review)
Review
Peripheral neuropathy (PN) is a common neurological problem defined as a dysfunction of sensory, motor, and autonomic nerves. The presence of peripheral neuropathy has recently been noticed in Parkinson's disease (PD) This comorbidity is concerning as it increases the burden on patients whose motor functions are previously compromised. A comprehensive computer-based literature review utilizing multiple peer-reviewed databases (e.g., Embase, PsycINFO, CINAHL, etc.) was conducted. There is evidence for the utility of robust diagnostic criteria to distinguish between large fiber neuropathy (LFN) and small fiber neuropathy (SFN). Some studies have established links between prolonged L-DOPA exposure and prevalence with increased levels of homocysteine (HCY) and methylmalonic acid (MMA) as pathological underlying mechanisms. PN in PD patients with relatively truncated exposure to L-DOPA therapy may have underlying mutations in the Parkin and MHTFR gene or separate mitochondrial disorders. Vitamin B12 and cobalamin deficiencies have also been implicated as drivers of PN. Accumulation of phosphorylated α-synuclein is another central feature in PN and deems urgent exploration via large cohort studies. Importantly, these underlying mechanisms have been linked to peripheral denervation. This review delves into the potential treatments for PN targeting B12 deficiencies and the use of COMT inhibitors along with other novel approaches. Avenues of research with powerful randomized controlled and long-term cohort studies exploring genetic mechanisms and novel treatment pathways is urgently required to alleviate the burden of disease exerted by PN on PD.
Topics: Humans; Levodopa; Methylmalonic Acid; Parkinson Disease; Peripheral Nervous System Diseases; Vitamin B 12
PubMed: 32358706
DOI: 10.1007/s10072-020-04407-4 -
Journal of Infusion Nursing : the... 2020Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It... (Review)
Review
Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.
Topics: Antineoplastic Agents; Humans; Nursing Assessment; Patient Education as Topic; Peripheral Nervous System Diseases; Quality of Life
PubMed: 32287170
DOI: 10.1097/NAN.0000000000000368 -
Handbook of Clinical Neurology 2017This chapter reviews the diseases of the peripheral nerves from a neuropathologic point of view, with a special focus on specific morphologic changes, and includes a... (Review)
Review
This chapter reviews the diseases of the peripheral nerves from a neuropathologic point of view, with a special focus on specific morphologic changes, and includes a summary of the histopathologic methods available for their diagnosis. As the rate of obesity and the prevalence of type 2 diabetes increase, diabetic neuropathy is the most common cause of peripheral neuropathy. Many systemic disorders with metabolic origin, like amyloidosis, hepatic failure, vitamin deficiencies, uremia, lipid metabolism disorders, and others, can also cause axonal or myelin alterations in the peripheral nervous system. The most notable causes of toxic neuropathies are chemotherapeutic agents, alcohol consumption, and exposure to heavy metals and other environmental or biologic toxins. Inflammatory neuropathies cover infectious neuropathies (Lyme disease, human immunodeficiency virus, leprosy, hepatitis) and neuropathies of autoimmune origin (sarcoidosis, Guillain-Barré syndrome/acute inflammatory demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy, and diverse forms of vasculitis. The increasing number of known diseases causing gene mutations in hereditary peripheral neuropathies requires precise characterization, which includes histopathology.
Topics: Animals; Humans; Peripheral Nervous System; Peripheral Nervous System Diseases
PubMed: 28987189
DOI: 10.1016/B978-0-12-802395-2.00031-6 -
Seminars in Neurology Oct 2019Peripheral neuropathy is a common neurological disorder, with high prevalence especially in the aged population. The general evaluative approach is to first identify the... (Review)
Review
Peripheral neuropathy is a common neurological disorder, with high prevalence especially in the aged population. The general evaluative approach is to first identify the type of peripheral neuropathy prior to investigating for a possible underlying etiology, which is an increasingly important endeavor, as many causes of peripheral neuropathy are now recognized as treatable. To this end, laboratory testing plays an important adjunctive role to a detailed history and examination. This review will discuss possible diagnostic laboratory testing pathways for different types of peripheral neuropathy, with the goal of minimizing costs and false-positive results while maximizing the likelihood of identifying a potentially reversible etiology.
Topics: Diagnosis, Differential; Humans; Laboratories; Nervous System Diseases; Peripheral Nervous System Diseases; Prevalence
PubMed: 31639836
DOI: 10.1055/s-0039-1691749 -
Seminars in Oncology Nursing Feb 2020To review assessment and management approaches for chemotherapy-induced peripheral neuropathy-related physical function deficits. (Review)
Review
OBJECTIVE
To review assessment and management approaches for chemotherapy-induced peripheral neuropathy-related physical function deficits.
DATA SOURCES
Peer-reviewed articles from PubMed, Ovid MEDLINE, CINAHL PsycINFO, SPORTDiscus, Scopus, and key studies' reference lists.
CONCLUSION
Brief clinical tests (eg, gait, Timed Up and Go) can screen for neuropathy-related physical function deficits. Exercise and physical therapy may be promising treatments, but the efficacy and optimal dose of such treatments for chemotherapy-induced peripheral neuropathy are unclear.
IMPLICATIONS FOR NURSING PRACTICE
Screening and assessment of neuropathy-associated physical function deficits should occur throughout neurotoxic chemotherapy treatment. If such deficits are identified, referral for rehabilitation (ie, physical or occupational therapy) and/or exercise interventions is warranted.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Oncology Nursing; Peripheral Nervous System Diseases; Physical Therapy Modalities; Practice Guidelines as Topic; Rehabilitation Nursing
PubMed: 31959510
DOI: 10.1016/j.soncn.2019.150983 -
Physical Medicine and Rehabilitation... Nov 2018Cancer treatments continue to advance the management and survival of patients. However, use of these regimens can lead to significant side effects both temporary and... (Review)
Review
Cancer treatments continue to advance the management and survival of patients. However, use of these regimens can lead to significant side effects both temporary and permanent. Neuromuscular side effects include chemotherapy-induced peripheral neuropathy and radiation fibrosis syndrome. At this time, the only way to resolve the neurotoxicity is reduction or discontinuation of the offending agent. In an attempt to limit interference with a patient's chemotherapy regimen and mitigate chronic disability, efforts for early detection through subjective clinical evaluations and objective measurement with electrodiagnostics can help to improve symptom management and minimize alteration in treatment.
Topics: Animals; Antineoplastic Agents; Electrodiagnosis; Humans; Neoplasms; Neurotoxicity Syndromes; Peripheral Nervous System Diseases; Radiation Injuries; Risk
PubMed: 30293625
DOI: 10.1016/j.pmr.2018.06.006