p101 neurotoxicity of high -dose carboplatin chemotherapy: a clinical and neurophysiological study
TRANSCRIPT
Communications affich6es/Postem 71s
P98
sTEROID THERAPY CAUSES CONDUCTION SLOWING IN HUMAN MUSCLE FIBERS
W. T r o n i , R. C a v a l l o , L. D u r e l l i and L. B e r g a m i n i , 1 s t N e u r o l o g i c a l C l i n i c , U n i v e r s i t y o f T u r i n ,
T u r i n ( I t a l y )
The p o s s i b l e d e l e t e r i o u s s i d e e f f e c t s o f h i g h - d o - sage s t e r o i d t h e r a p y ( h . s . t . ) on m u s c l e a r e known s i n c e t h e e a r l y r e p o r t by C u s h i n g ( 1 9 3 2 ) . H o w e v e r , c l i n i c a l and e l e c t r o p h y s i o l o g i c a l s t u d i e s on t h i s t o p i c a r e f e w , i n s p i t e o f t h e w i d e use o f h . s . t . i n c l i n i c a l p r a c t i c e . I n o r d e r t o i n v e s t i g a t e t h e t r u e i n c i d e n c e o f m u s c l e damage d u r i n g s t e r o i d t h e r a p y , we d e t e r m i n e d t h e c o n d u c t i o n v e l o c i t y o f t h e m u s c l e f i b e r s (m-CV) o f t h e b i c e p s , a c c o r d i n g t o t h e me thod d e s c r i b e d by T r o n i e t a l . ( 1 9 8 3 ) , i n 18 p a t i e n t s : t h e y w e r e 8 m a l e s and 10 f e m a l e s un - d e r h . s . t , f o r M y a s t h e n i a ( 6 ) , C h r o n i c O b s t r u c t i v e P u l m u n a r y D i s e a s e ( 4 ) , M u l t i p l e S c l e r o s i s (4 ) and E n d o c r a n i a l H y p e r t e n s i o n ( 4 ) . I n a l l o f t h e p a - t i e n t s t r e a t e d f o r more t h a n 2 - 3 w e e k s , m-CV was s i g n i f i c a n t l y r e d u c e d as c o m p a r e d t o t h a t o f c o n - t r o l s u b j e c t s matched f o r sex and age . The d e g r e e o f c o n d u c t i o n s l o w i n g was g r o s s l y c o r r e l a t e d t o t h e d u r a t i o n o f s t e r o i d t h e r a p y . The most u s u a l f i n d i n g was an i n c r e a s e d d i s p e r s i o n o f t h e l a t e n - c i e s o f s i n g l e f i b e r a c t i o n p o t e n t i a l s due t o t h e p r e s e n c e o f a m u s c l e f i b e r f r a c t i o n w i t h a v e r y low c o n d u c t i o n v e l o c i t y . A l t h o u g h t h e mean ing and t h e c l i n i c a l c o r r e l a t i o n o f t h i s e l e c t r o p h y s i o l o - g i c a l f i n d i n g i s u n c l e a r , some d e t r i m e n t a l effect on muscle seems to be a constant feature of h.s,t, Serial determination of m-CV is a usuful tool to monitor patients under steroid therapy. Moreover, m-CV studies may be an interesting approach to evaluate the myopathio effects of different ste- roids as well as to define therapeutic schedules able to minimize this harmful side effect.
PIO0
CENTRAL SOMATOSENSORY CONDUCTION IN DIABETES=
C.Maeztu,F:Martinez-Campillo,J.A.Munoz,L-G--Sic!
lia?A~Siaz-OrtuHo. Hoapital General.Murcia. SPAIN.
We have studied the spinal and supraspinal con-- duction in a group of 20 diabetic patients,using an indirect method that include median and tibia nerve stimulation. We have found a slowing of the Ll-cortex,Li-C 7 - and C7-cortex conductions. No correlation was found with metabolic control, duration of the d~sease and peripheral nerve -- conduction.This study suggest that in addition - to impairment of peripheral nerve conduction, - patients with diabetes can have a defect in spi- nal and supraspinal afferent conduction.
P99
USE OF SINGLE FIBRE EMG IN THE ASSESSMENT OF PATIENTS WITH
CHRONIC FATIGUE SYNDROMES.
S.Connolly, D.G.Smith, C.J.Fowler and D.Doyle.
Department of Clinical Neurophysiology, Middlesex Hospital,
London, Practice in Essex and Department of Neuropathology,
Southern General Hospital, Glasgow.
Single fibre (SF) EMG of extensor digitorum communis was
performed on 26 patients who had presented with a syndrome
of chronic fatigue, with or without myalgia. 22 patients had
m u s c l e b i o p s i e s . In 11 a p o s i t i v e d i a g n o s i s o f a c u t e o n s e t
p o s t v i r a l f a t i g u e was made as t h e r e was a h i s t o r y o f t h e i r
i l l n e s s b e i n g p r e c i p i t a t e d by a v i r a l i n f e c t i o n i n an
o t h e r w i s e h e a l t h y i n d i v i d u a l , 8 p a t i e n t s had c h r o n i c f a t i g u e
w i t h s y m p t o m s s i m i l a r t o t h o s e w i t h p o s t v i r a l f a t i g u e , b u t
t h e o n s e t o f t h e i r s y m p t o m s h a d b e e n i n s i d i o u s . T h e
remaining 7 patients w e r e clinically diagnosed as having
primary muscle disease because their predominant symptom was
of myalgia.
In 17 patients, 9 with post viral fatigue, mean jitter
was less than 37 usecs. In 6 patients increased fibre
d e n s i t y was f o u n d and i n 5 o f t h e s e p a t i e n t s t h e m u s c l e
b i o p s y was r e p o r t e d as b e i n g a b n o r m a l .
W h i l s t t h e r e r e m a i n s a m e d i c a l d i c h o t o m y as t o w h e t h e r
c h r o n i c f a t i g u e s y n d r o m e s a r e p h y s i c a l l y o r p s y c h i a t r i c a l l y
b a s e d , i t i s t h e r e s p o n s i b i l i t y o f t h e n e u r o p h y s i o l o g i s t t o
d e t e c t e L e c t r o m y o g r a p h i c e v i d e n c e o f m u s c l e d i s e a s e . We h a v e
f o u n d m e a s u r e m e n t o f f i b r e d e n s i t y t o be a s e n s i t i v e means
t o w a r d s t h i s a i m .
PIO1
NEUROTOXICITY OF HIGH -DOSE CARBOPLATIN CHEMQTHERAPY: A CLINICAL AND NEUROPHYSIOLOGICAL STUDY F. Rasi, F. Valzania, G. Rost i °, M, Marangolo ° Neurophys io l . Un i t , C i v i l Hosp i ta l , Cesena ( I t a l y ) o Medical Oncology Uni t , C i v i l Hosp i ta l , Ravenna ( I t a l y ) P.R. Ion 89110.1
Carbop la t in (JM8) is a d e r i v a t i v e compound of the second generat ion of p la t i num-con ta in ing drugs. I t has been wel l es tab l i shed t ha t JM8 has not renal t o x i c i t y and less n e u r o t o x i c i t y than c i s p l a t i n ; the main d o s e - l i m i t i n g side e f f e c t is myelosuppression. In consequence of t h i s exc lus i ve t o x i c i t y JM8 is a f i r s t choice drug fo r high dose chemotherapy, Per iphera l n e u r o t o x i c i t y xas examined in 9 p ts . s u f f e r i n g from germinal ce l l tumors before and one month a f t e r the t reatment by a score drawn from a p ro toco l i nc lud ing : Neuro log ica l Symptom and D i s a b i l i t y Score, Sympathetic Skin Ref lex , computerized Stab i lography and EMG (MCV and F wave o f peroneal n . , SCV of sura l n . , SCV and MCV and F wave of median n. ) According to the score, f i v e degrees o f per iphera l nerve involvement were considered: Absent, Border l ine , M i ld , Moderate, Severe. Brain t o x i c i t y was examined by means of VEP and BAEP. Before t reatment p ts . showed a mean score o f 4.87 and were c l a s s i f i e d as fo l l ows : I p t . Border l ine , 6 Mi ld , 2 Moderate. One month a f t e r therapy the mean score was 6.37 and the c l a s s i f i c a t i o n was: 7 Mi ld , I Moderate, I Severe. EP study was normal but 2 pts. s u f f e - r ing from bra in metastasis. The su rve i l l ance of drug n e u r o t o x i c i t y showed a s l i g h t increase o f the score w i thout any s i g n i f i c a n t s h i f t i n g toward a more severe n e u r o t o x i c i t y . Even i f l i m i t e d , our data do not show s i g n i f i c a n t n e u r o t o x i c i t y due to high-dose ca rbop la t i n chemotherapy.