Oxaliplatin-induced lhermitte's phenomenon as a manifestation of severe generalized neurotoxicity.
OBJECTIVE
Lhermitte's phenomenon, characterized by 'electric-shock' sensations precipitated by neck flexion, may develop during oxaliplatin treatment. Limited cases have been described previously and the pathophysiology underlying Lhermitte's phenomenon in oxaliplatin-treated patients has not been established.


METHODS
Patients who developed Lhermitte's phenomenon during oxaliplatin therapy were investigated by neurological examination, neurotoxicity grading and conventional nerve conduction studies (NCS). Structural (magnetic resonance imaging) and functional (somatosensory evoked potentials) spinal assessment was also undertaken. Sensory nerve excitability recordings were performed longitudinally across treatment to investigate ion channel function.


RESULTS
Five oxaliplatin-treated patients reported Lhermitte's phenomenon, with a mean cumulative dose of 861 +/- 84 mg/m(2) oxaliplatin (range 574-1,100 mg/m(2)). NCS revealed severe sensory neuropathy in all patients. There was no evidence of structural or functional spinal cord damage. Nerve excitability studies revealed progressive alterations in sensory excitability throughout treatment, consistent with oxaliplatin-induced nerve dysfunction. In patients with Lhermitte's phenomenon, refractoriness was reduced to -14.4% (confidence interval, CI: -20.5 to -8.4%) by late treatment, a significantly greater reduction than in oxaliplatin-treated patients who did not develop Lhermitte's phenomenon (-2.7%; CI: -7.6 to 2.2; p = 0.013).


CONCLUSIONS
Lhermitte's phenomenon represents a severe presentation of oxaliplatin-induced neurotoxicity, associated with generalized nerve dysfunction in the absence of structural spinal abnormalities.
Park
Susanna B
SB
Prince of Wales Medical Research Institute and Prince of Wales Clinical School, Sydney, NSW, Australia.
Lin
Cindy S-Y
CS
Krishnan
Arun V
AV
Goldstein
David
D
Friedlander
Michael L
ML
Kiernan
Matthew C
MC
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D020258:Neurotoxicity Syndromes / Q000150:complications*; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010292:Paresthesia / Q000139:chemically induced*
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin