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Condition/Disorder Synonyms

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  • Anti-neoplastic neuropathy

  • Drug-induced neuropathy or neuronopathy

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ICD-9-CM Code

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  • 357.6 Polyneuropathy due to drugs

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ICD-10-CM Code

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  • G62.0 Drug-induced polyneuropathy

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Preferred Practice Pattern1

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  • 5G: Impaired motor function and sensory integrity associated with acute or chronic polyneuropathies

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Key Features

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Description

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  • Damage to nerve cells of the peripheral nervous system

  • Numbness, tingling in the hands and feet

  • Peripheral neuropathy

  • Patients may experience painful peripheral neuropathy

  • Predominantly sensory polyneuropathy beginning several weeks after the completion of antineoplastic drug therapy

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Essentials of Diagnosis

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  • Change in symptoms can be sudden or appear slowly

  • Severity of polyneuropathy is dose- and time-dependent

  • Concentration of platinum in the peripheral nervous system is correlated to degree of pathologic changes; greatest concentrations generally found in the dorsal root ganglia, but can become concentrated in dorsal columns of the spinal cord

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General Considerations

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  • Most common medications involved are

    • Cisplatin

    • Carboplatin

    • Paclitaxel

    • Docetaxel

    • Vincristine

    • Vinblastine

    • Vinorelbine

    • Thalidomide

  • Most of these drugs cause axonal damage with secondary demyelination; may be partially reversible after the drug is discontinued

  • Many are also ototoxic, cause autonomic dysfunction, or lead to seizures

  • Chemotherapy-related fatigue is common and will impact assessment and treatment of those with chemotherapy-induced polyneuropathy

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Demographics

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  • Adults more commonly affected than children

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Clinical Findings

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Signs and Symptoms

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  • Numbness of hand, feet, mouth area

  • Tingling

  • Loss of sensation to light touch

  • Loss or impairment of deep-tendon reflexes

  • Loss or impairment of vibration and proprioception

  • Pain, burning, stabbing

  • Impaired balance

  • Altered gait pattern

  • Constipation

  • Impaired vestibular function

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Functional Implications

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  • Difficulty with fine motor tasks (e.g., writing, grooming, cooking, feeding, bathing) due to loss of sensation

  • Fall risk with mobility on uneven/unpredictable surfaces

  • Injury risk with items of unknown sharpness or temperature

  • Difficulty with gross motor tasks (e.g., transfers, gait, stair climbing, dressing) due to loss of sensation

  • Balance problems due to loss of sensation or ototoxicity

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Possible Contributing Causes

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  • Chemotherapy to treat cancers may cause polyneuropathy, depending on duration of chemotherapy treatment

  • Diabetes

  • Alcoholism

  • Malnutrition

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Differential Diagnosis

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  • Guillain–Barré syndrome

  • Tabes dorsalis

  • Peripheral vascular disease

  • HIV-related neuropathy

  • Polyarteritis nodosa

  • Diabetes mellitus

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Means of Confirmation or Diagnosis

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Diagnostic Procedures

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  • Nerve conduction velocity (NCV) testing

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Referrals/Admittance

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  • To oncologist if chemotherapy-related

  • To occupational therapist for assistance with fine motor activities and activities of daily living (ADLs)

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Impairments

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  • Peripheral nerve integrity

  • Gait training

  • Balance

    • Static standing

    • Dynamic standing

    • Moving base-of-support standing

  • Range of motion ...

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