Thalidomide neuropathy: clinical, electrophysiological and neuroradiological features.
OBJECTIVE
Thalidomide is a promising therapy for multiple myeloma. Sensory neuropathy is a side effect of thalidomide and resulted to be partially reversible in 50% of cases, suggesting a sensory ganglionopathy. Spinal cord magnetic resonance imaging (MRI) was found to be useful in the diagnosis of sensory ganglionopathies and we use it to determine if thalidomide neuropathy has features of a ganglionopathy.


METHODS
Six patients with multiple myeloma developed thalidomide-induced polyneuropathy. Nerve conduction studies, somatosensory-evoked potentials (SEPs) and cervical and dorsal spinal cord MRI were obtained in all.


RESULTS
All patients had a sensory neuropathy, with clinical or electrophysiological abnormalities involving all four limbs. Spinal cord MRI showed high signal intensity in the posterior columns in only one patient, with abnormal central conduction time at SEPs.


CONCLUSIONS
Our results suggest that thalidomide can induce either an axonal length-dependent neuropathy or, less frequently, a ganglionopathy.
Isoardo
G
G
Dipartimento di Neuroscienze, Università di Torino, Torino, Italia. dariococito@yahoo.it
Bergui
M
M
Durelli
L
L
Barbero
P
P
Boccadoro
M
M
Bertola
A
A
Ciaramitaro
P
P
Palumbo
A
A
Bergamasco
B
B
Cocito
D
D
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001369:Axons / Q000187:drug effects / Q000473:pathology / Q000502:physiology; D019054:Evoked Potentials, Motor / Q000187:drug effects / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005727:Ganglia, Spinal / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects / Q000502:physiology; D009101:Multiple Myeloma / Q000188:drug therapy*; D018482:Muscle, Skeletal / Q000294:innervation; D009431:Neural Conduction / Q000187:drug effects*; D009460:Neurologic Examination / Q000187:drug effects; D011115:Polyneuropathies / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D013792:Thalidomide / Q000009:adverse effects* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D013792:Thalidomide