Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy.
Oxaliplatin, a platinum-based chemotherapeutic agent, is effective in the treatment of solid tumors, particularly colorectal cancer. During and immediately following oxaliplatin infusion, patients may experience cold-induced paresthesias, throat and jaw tightness, and occasionally focal weakness. We assessed nerve conduction studies and findings on needle electromyography of patients with metastatic colorectal cancer before and during treatment with oxaliplatin. Twenty-two patients had follow-up studies within 48 h following oxaliplatin infusions, and 14 patients had follow-up studies after 3-9 treatment cycles. Repetitive compound muscle action potentials and neuromyotonic discharges were observed in the first 24-48 h following oxaliplatin infusion, but resolved by 3 weeks. After 8-9 treatment cycles, sensory nerve action potential amplitudes declined, without conduction velocity changes or neuromyotonic discharges. The acute neurological symptoms reflect a state of peripheral nerve hyperexcitability that likely represents a transient oxaliplatin-induced channelopathy. Chronic treatment causes an axonal neuropathy similar to other platinum-based chemotherapeutic agents.
Department of Neurology, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. TJLehky@Bethesda.med.navy.mil
T J
TJ
Lehky
G D
GD
Leonard
R H
RH
Wilson
J L
JL
Grem
M K
MK
Floeter
D000200:Action Potentials / Q000187:drug effects / Q000502:physiology; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy*; D002908:Chronic Disease; D003110:Colonic Neoplasms / Q000188:drug therapy*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007473:Ion Channels / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010292:Paresthesia / Q000139:chemically induced / Q000503:physiopathology; D010525:Peripheral Nerves / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology
D000970:Antineoplastic Agents; D007473:Ion Channels; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin