Peripheral Neuropathy

NOVEMBER 29, 2010

Associations Between Oxaliplatin-induced Peripheral Neuropathy and Polymorphisms of the ERCC1 and GSTP1 Genes

Journal: International Journal of Clinical Pharmacology and Therapeutics (November 2010)
Authors: Inada M, Sato M, Morita S, et al.
Purpose: To “explore the pharmacogenetic association between oxaliplatin-induced neuropathy and polymorphisms of the excision repair cross-complementation Group 1 (ERCC1) and glutathione-S-transferases pi 1 (GSTP1) genes.”
Results: “ERCC1, C118T and GSTP1 Ile105Val polymorphisms are more strongly related to the time until onset of neuropathy than to the grade of neuropathy,” most likely influencing neuropathy sensitivity.
European Federation of Neurological Societies/Peripheral Nerve Society Guideline on Management of Paraproteinemic Demyelinating Neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society—First Revision
Journal: Journal of the Peripheral Nervous System (October 28, 2010; online ahead of print)
Authors: Hadden R, Nobile-Orazio E, Sommer C, et al.
Purpose: To “update the 2006 EFNS/PNS guideline on management of patients with a demyelinating neuropathy and a paraprotein (paraproteinemic demyelinating neuropathy [PDN]) by review of evidence and expert consensus.”
Results: “(1) patients with PDN should be investigated for a malignant plasma cell dyscrasia; (2) a monoclonal gammopathy of undetermined significance is more likely to be causing the neuropathy if it is immunoglobulin (Ig)M, anti-neural antibodies are present, and the clinical phenotype is chronic distal sensory neuropathy; (3) patients with IgM PDN usually have predominantly distal sensory impairment, prolonged distal motor latencies, and often anti-myelin-associated glycoprotein antibodies; (4) IgM PDN may respond to immunomodulatory therapies. Their potential benefit should be balanced against possible side effects and the usually slow disease progression; (5) IgG and IgA PDN may be indistinguishable from chronic inflammatory demyelinating polyradiculoneuropathy; and (6) Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes syndrome is a multi-system malignant PDN.”
Peripheral Neuropathy in Patients with Gynecologic Cancer Receiving Chemotherapy: Patient Reports and Provider Assessments
Journal: Oncology Nursing Forum (November 2010)
Authors: Kiser D, Greer T, Wilmoth M, et al.
Purpose: “To analyze the incidence of chemotherapy-induced neuropathy in a set of patients with gynecologic cancer who were treated with known neurotoxic agents, to identify correlative factors related to patients' experience of neuropathy, and to analyze providers' assessment and treatment of neuropathy.”
Results: Findings suggest that completion of first-line therapy for gynecologic malignancy allows for improved neuropathy, with second-line therapies not necessarily correlating with worsening scores.
Pilot Study: Does Lower Extremity Night Splinting Assist in the Management of Painful Peripheral Neuropathy in the HIV/AIDS Population?
Journal: Journal of the International Association of Physicians in AIDS Care (November 12, 2010; online  ahead of print)
Authors: Sandoval R, Runft B, Roddey T
Purpose: To “assess the effects of using night splints on pain and sleep quality” in patients living with HIV/AIDS and a diagnosis of peripheral neuropathy.
Results: Significant changes in pain and sleep index scores were seen following the use of night splints.
Clinical Trials
Diffusion Tensor Imaging of Sural Nerves in Diabetic Peripheral Neuropathy
Study Type: Observational
Age/Gender Requirement: 18-70 years (male/female)
Sponsor: University of Michigan
Purpose: To “validate magnetic resonance imaging and diffusion tensor imaging (MRI/ DTI) analysis as a non-invasive method for the assessment of myelinated nerve fibers loss in diabetic peripheral neuropathy.”
Efficacy of Inhaled Cannabis in Diabetic Painful Peripheral Neuropathy
Study Type: Interventional
Age/Gender Requirement: 18 years (male/female)
Sponsor: Center for Medicinal Cannabis Research
Purpose: To “determine if vaporized cannabis is effective as an analgesic for the treatment of painful diabetic neuropathy.”
Electrical Stimulation Therapy Using the MC5-A Scrambler in Reducing Peripheral Neuropathy Caused by Chemotherapy
Study Type: Interventional
Age/Gender Requirement: 18 years (male/female)
Sponsor: Massey Cancer Center
Purpose: To “determine if MC5-A Scrambler therapy will improve the pain associated with chemotherapy-induced peripheral neuropathy in cancer patients by 20%.”
Medical Websites
The Foundation for Peripheral Neuropathy
Resources for professionals at this site include recent research news items, ongoing clinical trials, how to apply for grant funding, and hospitals and universities associated with the FPN that may help physicians find new treatment options. The “Living with Peripheral Neuropathy” section includes information about causes, symptoms, and coping skills that physicians can direct patients to. The FPN also provides physicians with information about upcoming conferences and events, and a monthly newsletter that discusses “research news, treatment options, and more.”
The Educated PatientTM
About Peripheral Neuropathy
This site’s description of the peripheral nervous system includes a written discussion and an illustration of the human body, with the different nervous systems highlighted. The differences between polyneuropathy and mononeuropathy, as well as how the two can develop, are explained. Causes of PN include poor nutrition, diabetes, hereditary disorders, and more. The site explains how each cause can lead to PN, signs and symptoms, diagnostic tests, and treatment options.
The Neuropathy Association
Ongoing research efforts, support groups, and facts about neuropathy—signs and symptoms, treatments, and more—are all discussed here. Patients can share stories about living with neuropathy, learn about ongoing research, and read about recent neuropathy news. Two videos featured on the site discuss how volunteering can improve health and feelings of wellness, and the introduction of new legislation that is attempting to “remedy inadequate Medicare reimbursements currently restricting patient access to IVIG.”
Peripheral Neuropathy
In addition to general information about PN, including signs, risk factors, complications and more, this site also includes a slide show of brain anatomy. These slides provide a general overview of the brain’s structure and how nerves work. Pharmacologic treatment options are explored, and the site also discusses how patients can use alternative medicine or make lifestyle changes to manage symptoms.
Peripheral Neuropathy Fact Sheet
Trauma, systemic diseases, infections and autoimmune disorders, and genetics are all causes of PN. This site discusses how each different one can lead to PN, and how the symptoms of each vary. Diagnosis, treatment options, and ongoing research of PN in general, and the types that are caused by something specific, such as diabetic PN or inherited PN, are also discussed.
Pharma Focus
Clinical Trials
Combination Pain Therapy in HIV Neuropathy
Study Type: Interventional
Age/Gender Requirement: 18 years (male/female)
Sponsor: National Institute of Allergy and Infectious Diseases
Purpose: To compare methadone alone to duloxetine alone and combination duloxetine and methadone in ability to reduce neuropathy-associated pain in people living with HIV infection.
Duloxetine in Treating Peripheral Neuropathy Caused by Chemotherapy in Patients with Cancer
Study Type: Interventional
Age/Gender Requirement: 25 years (male/female)
Sponsor: Cancer and Leukemia Group B
Purpose: To “determine the efficacy of duloxetine hydrochloride in cancer patients with painful chemotherapy-induced (taxane or platinum agent) peripheral neuropathy,” looking particularly at functional status and quality of life.
From the HCPLive Network
Japan Approves Lyrica for Peripheral Neuropathic Pain
Lyrica capsules were previously approved in the treatment of postherpetic neuralgia and are the first treatment for PNP in Japan.
Topical Agent for Diabetic Neuropathy on FDA Fast Track
Drug for diabetic neuropathic pain receives FDA fast track designation.

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