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Peripheral Neuropathy
Chemotherapy-related Causes of Peripheral Neuropathy Some chemotherapeutic drugs can cause damage to peripheral nerves. Vinca (Plant) Alkaloids Vinca (Plant) alkaloids such as vincristine can cause neuropathy. Other vinca alkaloids may also cause damage to the peripheral nerves. Here is a list of some of them, in order of decreasing risk for peripheral neuropathy:
Vincristine can cause damage to small nerve fibers carrying the sensations of pain and temperature. Initially, you may feel a tingling sensation in your toes and fingertips. The tingling and/or burning sensation caused by vincristine usually begin in the toes and fingertips on both sides of your body. These sensations, known as paresthesias can move from the fingertips to the hands and wrist and from the toes to the feet. The discomfort is usually worse in the toes and feet than the fingertips and hands. With repeated doses of the vincristine, changes in the muscle function can occur as well. You might notice weakness in your wrists and feet. This can result in a wrist drop or foot drop. Wrist drop is caused when muscles in your hand become weak. You may find it difficult to hold your hand out in line with your lower forearm. Foot drop is caused when the muscles in your feet and ankles become weak because of injury to the nerves. You may notice changes in your walking such as your toes touching the ground before your heels. There are nerve fibers that help the muscles around your colon move stool through your body. Peripheral neuropathy can slow down the movement of stool through your colon. You may notice changes in your bowel movements and may experience constipation. The changes in sensation may resolve quickly, or can take months to years to resolve. Cisplatin can also cause peripheral neuropathy even when the treatment has stopped. You may notice changes in sensation and movement such as holding a glass securely in your hands. You may develop a hypersensitivity to pain known as hyperalgesia. The changes in sensation usually occur in the toes and fingertips and can progress into the feet and hands. This is what is known as a stocking-glove distribution. With the changes in sensation, you may notice changes in movement. For example, the sensory changes in your hands may make it difficult to button your shirts or with writing. Changes in your muscle can occur which can lead to muscle weakness and cramping. You may notice changes in your balance, and to compensate, your legs automatically have moved further apart – this helps you to maintain balance. An electrical shock sensation down your back when your neck is flexed can occur. This is called Lhermitte’s sign. This electrical shock sensation is a very rare side effect of the drug and usually goes away after treatment. Cisplatin can also cause hearing and visual changes. The drug can affect your ears and, if this occurs, the first change you would notice is ringing in the ears (tinnitus). If the changes in hearing progress, you can lose medium-frequency hearing.12 Visual changes include blurred vision and impaired color vision.12 Carboplatin, a drug that is similar to cisplatin, can also cause peripheral neuropathy but not to the same degree that cisplatin can. Oxaliplatin is another drug related to cisplatin. The tingling and cramping in your fingers can begin 30-60 minutes after the infusion. This drug can cause paresthesias and muscle cramping of the fingers and hands. The problem seems to worsen when you expose your fingers and hands to extreme cold, such as reaching into a freezer. Paclitaxel (Taxol®) can also cause peripheral neuropathy, especially when given with cisplatin or alone in high doses. Paclitaxel causes paresthesias of the hands and feet and presents in the stocking-glove distribution. This drug can also cause a tingling and numbness around the mouth. Muscle weakness can occur making tasks such as buttoning a shirt or climbing stairs difficult. This drug can also cause an unsteady gait (especially in the dark) because of the change in position sense, mild muscle weakness, and muscle pain that starts 1-2 days after infusion and resolves in 4-7 days. Docetaxel (Taxotere) can cause paresthesias and dysesthesias (an abnormal perception of pain), and pain, especially if this drug is given with other drugs such as cisplatin, oxaliplatin, or vinorelbine. As with Taxol®, this drug can cause an unsteady gait. Bortezomib (Velcade®) can cause symptoms such as burning sensation, numbness, increased or decreased sensation, pain, or discomfort associated with peripheral neuropathy. Thalidomide can cause paresthesias and hyperesthesia. |
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