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  • Anti-neoplastic neuropathy
  • Drug-induced neuropathy or neuronopathy

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  • 357.6 Polyneuropathy due to drugs

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  • G62.0 Drug-induced polyneuropathy

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

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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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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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Diagnostic Procedures

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  • Nerve conduction velocity (NCV) testing

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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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  • Peripheral nerve integrity
  • Gait training
  • Balance
    • Static standing
    • Dynamic standing
    • Moving base-of-support standing
  • Range of motion (ROM)
  • Endurance
  • Aerobic capacity
  • Self-care
  • Home management

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  • Sensory testing
  • Cranial nerve testing
  • Reflex testing
  • Muscle tone
  • Manual muscle test
  • Active and passive ROM testing, muscle-length testing
  • Functional assessment (assist, device, environment)
    • Bed mobility
    • Transitions
    • Sitting balance
    • Standing balance
    • Transfers
    • Gait
    • Stairs
  • Pain assessment
  • Postural assessment
  • Cardiovascular endurance

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  • Massage to increase circulation
  • ...

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