title: Drug-induced dysimmune demyelinating neuropathies.
abstract: Drug-induced peripheral neurotoxicity usually manifests as a length-dependent, "dying back" axonal, predominantly sensory polyneuropathy. Rarely, immune-mediated demyelinating neuropathies occur during initial or maintenance treatment with immunomodulatory, immunosuppressive or antineoplastic agents. Medication-induced immune perturbation presumably triggers a dysimmune attack directed at unidentified peripheral nerve myelin epitopes; true peripheral nerve toxicity (i.e., dependent on accumulative dose or serum level) plays no identified role. The mechanisms that underlie a paradoxical and unpredictable immune exacerbation are unclear, and may depend on patient age, drug dosage and schedule, time of treatment relative to disease course, and host genetic factors. Suspicion and recognition of a non-toxic, immune-mediated demyelinating process has management (targeted immunotherapy) and prognostic (mostly favorable) implications.
authors.affiliation: Department of Neurology and Neuroscience, Weill Medical College of Cornell University/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA. pstuebge@med.cornell.edu
authors.forename: Joerg-Patrick
authors.initials: JP
authors.lastname: Stübgen
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D009186:Myelin Sheath / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D010525:Peripheral Nerves / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology*; D011129:Polyradiculoneuropathy / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology*
chemical_list: D000970:Antineoplastic Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents