An Update on Toxic and Drug-Induced Peripheral Neuropathies
An Update on Toxic and Drug-Induced Peripheral Neuropathies
Purpose of review: This review discusses publications highlighting current research on toxic, chemotherapy-induced peripheral neuropathies (CIPNs), and drug-induced peripheral neuropathies (DIPNs).
Recent findings: The emphasis in clinical studies is on the early detection and grading of peripheral neuropathies, whereas recent studies in animal models have given insights into molecular mechanisms, with the discovery of novel neuronal, axonal, and Schwann cell targets. Some substances trigger inflammatory changes in the peripheral nerves. Pharmacogenetic techniques are underway to identify genes that may help to predict individuals at higher risk of developing DIPNs. Several papers have been published on chemoprotectants; however, to date, this approach has not been shown effective in clinical trials.
Summary: Both length and nonlength-dependent neuropathies are encountered, including small-fiber involvement. The introduction of new diagnostic techniques, such as excitability studies, skin laser Doppler flowmetry, and pharmacogenetics, holds promise for early detection and to elucidate underlying mechanisms. New approaches to improve functions and quality of life in CIPN patients are discussed. Apart from developing less neurotoxic anticancer therapies, there is still hope to identify chemoprotective agents (erythropoietin and substances involved in the endocannabinoid system are promising) able to prevent or correct painful CIPNs.
Drug-induced peripheral neuropathies (DIPNs) are uncommon, but with the number of new drugs increasing, unusual side effects may not become apparent until after widespread usage. Chemotherapy-induced peripheral neuropathies (CIPNs) are major and dose-limiting side effects of many anticancer treatments, and their characteristics are often related to both the choice of anticancer drugs and the cumulative doses. Toxic, DIPNs, and CIPNs may appear as length or nonlength-dependent neuropathies, with or without small-fiber involvement, and discussions about grading the severity and early detection of neuropathies are still open. Recent publications have revealed new insights into the description and understanding of the pathophysiology and individual susceptibility factors, paving the way for the development of new prophylactic and therapeutic measures.
Abstract and Introduction
Abstract
Purpose of review: This review discusses publications highlighting current research on toxic, chemotherapy-induced peripheral neuropathies (CIPNs), and drug-induced peripheral neuropathies (DIPNs).
Recent findings: The emphasis in clinical studies is on the early detection and grading of peripheral neuropathies, whereas recent studies in animal models have given insights into molecular mechanisms, with the discovery of novel neuronal, axonal, and Schwann cell targets. Some substances trigger inflammatory changes in the peripheral nerves. Pharmacogenetic techniques are underway to identify genes that may help to predict individuals at higher risk of developing DIPNs. Several papers have been published on chemoprotectants; however, to date, this approach has not been shown effective in clinical trials.
Summary: Both length and nonlength-dependent neuropathies are encountered, including small-fiber involvement. The introduction of new diagnostic techniques, such as excitability studies, skin laser Doppler flowmetry, and pharmacogenetics, holds promise for early detection and to elucidate underlying mechanisms. New approaches to improve functions and quality of life in CIPN patients are discussed. Apart from developing less neurotoxic anticancer therapies, there is still hope to identify chemoprotective agents (erythropoietin and substances involved in the endocannabinoid system are promising) able to prevent or correct painful CIPNs.
Introduction
Drug-induced peripheral neuropathies (DIPNs) are uncommon, but with the number of new drugs increasing, unusual side effects may not become apparent until after widespread usage. Chemotherapy-induced peripheral neuropathies (CIPNs) are major and dose-limiting side effects of many anticancer treatments, and their characteristics are often related to both the choice of anticancer drugs and the cumulative doses. Toxic, DIPNs, and CIPNs may appear as length or nonlength-dependent neuropathies, with or without small-fiber involvement, and discussions about grading the severity and early detection of neuropathies are still open. Recent publications have revealed new insights into the description and understanding of the pathophysiology and individual susceptibility factors, paving the way for the development of new prophylactic and therapeutic measures.
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