Childhood thalidomide neuropathy: a clinical and neurophysiologic study.
Thalidomide was recently reintroduced to treat several immune-mediated pathologies. Peripheral neuropathy is a significant side effect limiting its clinical use. Our aims include: (1) describing and identifying the incidence of clinical or electrophysiologic peripheral neuropathy in children, (2) determining whether peripheral neuropathy correlates with cumulative dose of thalidomide and with age, and (3) defining its reversibility rate. We studied 13 children manifesting immune-mediated pathologies treated with thalidomide at doses ranging from 25-100 mg/day. Clinical and neurophysiologic evaluation was performed before and after starting treatment. Seven children (53.8%) showed neurophysiologic signs of sensory peripheral axonal polyneuropathy. Five presented associated clinical symptoms, while the other two only presented subclinical, neurophysiologic signs of peripheral neuropathy. We found a significant correlation between the incidence of peripheral neuropathy and thalidomide cumulative dose (P = 0.02). We observed a lower incidence of peripheral neuropathy at a cumulative dose <20 gm, and a correlation with age (P < 0.01). The clinical and electrophysiologic recovery rate was 40%, and clinical improvement alone was observed in another 40%. Thalidomide induces dose-dependent and age-dependent peripheral neuropathy at a significant frequency in childhood (53.8%). In our experience a cumulative dosage at >20 gm and long-term administration for >10 months seem to increase the risk of peripheral neuropathy. We propose clinical and neurophysiologic follow-up every 3 months to identify and monitor possible side effects.
Priolo
Tiziana
T
Children's Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Largo Gaslini 5, Genoa, Italy.
Lamba
Laura Doria
LD
Giribaldi
Gaia
G
De Negri
Emanuela
E
Grosso
Paolo
P
De Grandis
Elisa
E
Veneselli
Edvige
E
Buoncompagni
Antonella
A
Viola
Stefania
S
Alpigiani
Maria Giannina
MG
Gandullia
Paolo
P
Calevo
Maria G
MG
D000200:Action Potentials / Q000187:drug effects / Q000502:physiology / Q000528:radiation effects; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects; D009431:Neural Conduction / Q000187:drug effects / Q000502:physiology / Q000528:radiation effects; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D013792:Thalidomide / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D013792:Thalidomide