Objectives:To characterize the natural history of oxaliplatin-associated neuropathy (ON) and determine whether intraepidermal nerve fiber density (IENFD) is a sensitive measure of neuropathy progression. In addition, we sought to assess the potential of ON as a neuroprotection model and gain insight into the relationship between axon loss and neuropathic symptoms.Methods: Eight subjects receiving oxaliplatin for advanced colorectal cancer were prospectively followed prior to starting chemotherapy and at 30, 90, 180, and 360 days (180 days after completing treatment). Electrophysiology, punch biopsies, symptom assessment, and examinations with calculation of a reduced total neuropathy score (rTNS) were performed at each time point. Changes over time were assessed through Poisson regression for IENFD and a mixed effects model for rTNS and electrophysiology measures. Results:The distal leg IENFD, rTNS, peroneal, and sural amplitudes were all significantly reduced over time, while conduction velocity (peroneal and sural) and distal thigh IENFD were not. Measures of axon loss continued to worsen following discontinuation of oxaliplatin. Five of 8 subjects reported prominent symptoms associated with oxaliplatin administration. Conclusions:This study demonstrates that oxaliplatin is associated with mild, sensory, and motor axon loss that may not be reversible. Axonal loss was detected by electrophysiology, rTNS, and distal leg IENFD. Several subjects reported prominent sensory symptoms that were not associated with axon loss, and that may or may not represent neuropathy. ON is an attractive paradigm for neuroprotection studies and the distal leg IENFD is an objective measure that requires minimal subject participation or study site expertise. Neurology ® 2011;77:980-986 GLOSSARY 5-FU ϭ fluorouracil; IENFD ϭ intraepidermal nerve fiber density; NCV ϭ nerve conduction velocity; ON ϭ oxaliplatinassociated neuropathy; PN ϭ peripheral neuropathy; rTNS ϭ reduced total neuropathy score.Oxaliplatin (Sanofi-Aventis; Bridgewater, NJ) is a third-generation platinum derivative that has enhanced inhibition of DNA repair and replication. Oxaliplatin is an antineoplastic agent currently indicated for the treatment of advanced cancer of the colon or rectum.1 A doselimiting toxicity of oxaliplatin is peripheral neuropathy (PN). As oxaliplatin-containing regimens become more successful, the number of long-term survivors will likely increase and neuropathy may emerge as a more important factor limiting quality of life. [1][2][3][4][5] In addition, "stop-and-go" dosing regimens have been adopted in an effort to reduce chronic neuropathy development 1,6,7 and underscores the importance of better understanding this neuropathy. Unpleasant paresthesias in the distal extremities, mouth, and throat are common adverse events associated with acute oxaliplatin administration while a distal length-dependent neuropathy develops with total doses Ն540 -850 mg/m 2 . 2,8The symptoms, functional impairment, and motor axon excitability 9 associate...

Normal bladder function depends on the complex interaction of sensory and motor pathways. Bladder dysfunction can develop as a result of several neurological conditions. It can happen in a number of ways, including diabetic cystopathy, detrusor overactivity, bladder outlet obstruction, and urge and stress urinary incontinence. Diabetic neuropathy is the most common cause of peripheral neuropathy-associated bladder dysfunction. Guillain-Barré syndrome (GBS), human immunodeficiency virus (HIV)-associated neuropathy, chronic inflammatory demyelinating polyneuropathy (CIDP), and amyloid neuropathy are other major causes. The diagnosis of bladder dysfunction should be established by the history of neurological symptoms, neurological examination, and urological evaluation. Functional evaluation of the lower urinary tract includes cystometry, sphincter electromyography, uroflowmetry, and urethral pressure profilometry. Management of urinary symptoms in patients with bladder dysfunction is usually supportive. In some cases, alpha-blocker and/or anti-muscarinic agents are needed to help improve urinary dysfunction. Intermittent self-catheterization is needed occasionally for patients with slow and/or poor recovery.

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PURPOSE: To assess the repeatability of measurements of higher order aberrations using three different aberrometers and to compare higher order aberration measurements between optical path difference (OPD) scanning and the Hartmann-Shack method. METHODS: Wavefront aberration data obtained using the NIDEK OPD-Scan, Bausch & Lomb Zywave wavefront aberrometer, and VISX CustomVue wavefront analyzer were compared. A total of 19 subjects were included in the study. The repeatability in each machine was assessed by calculating the difference between measurements and the mean of three consecutive measurements in the same eye. Subsequent analysis of the distribution of these differences yields the mean difference, the standard deviation of the differences, and the 95% confidence interval for repeated measurements, also termed the "repeatability coefficient." RESULTS: Repeatability errors in all three machines were found to be low, suggesting that all three machines are reliable in their repeated measurements. Significant differences were demonstrated between OPD scanning and Hartmann-Shack aberrometers. All three machines showed statistically significant differences in several higher order aberration parameters when compared to each other. CONCLUSIONS: The three different aberrometers provided repeata ble measurements but statistical differences were noted in the measurement of higher order aberrations when comparing the machines. No instrument was superior over the other and all three were reliable. [J Refract Surg. 2006;22:898-903.]

Common peripheral neuropathies do not usually cause diaphragmatic weakness and subsequent respiratory compromise. However, respiratory involvement is relatively common in Guillain-Barré syndrome (GBS). Experience in GBS has led to a standardized approach to manage respiratory problems in peripheral neuropathies. Diaphragmatic weakness is not common in chronic inflammatory demyelinating polyneuropathy and extremely rare in multifocal motor neuropathy. The linkage has been described between certain subtypes of Charcot-Marie-Tooth (CMT) disease such as CMT2C and CMT4B1 and diaphragmatic weakness. A correlation usually has not been found between electrophysiologic findings and clinical respiratory signs or spirometric abnormalities in peripheral neuropathies except in amplitudes of evoked phrenic nerve responses. Careful and frequent assessment of respiratory function by a qualified team of healthcare professionals and physicians is essential. Criteria established for mechanical ventilation in GBS cases may be applied to other peripheral neuropathies with respiratory compromise as necessary.

Optic neuritis (ON) is one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas. Careful and detailed examination and investigation are warranted to make the diagnosis. We report this case to increase awareness of clinicians to include Lyme disease in differential diagnosis of ON for unexplained cases of ON. Herein we present a unique case with a unilateral ON caused by LD along with pre- and posttreatment findings and literature review.

Corneal shield ulcers and plaques are rare but serious complications of vernal keratoconjunctivitis, which may be unresponsive to standard medical therapy. Surgical debridement is a fast and effective procedure yielding rapid healing of the ulcer and minimizing complications, such as infections.

The diagnosis of Lyme disease can be very challenging and it can mimic other neurological disorders such as ALS or Guillain-Barre syndrome (GBS). Careful and detailed examination and investigation are required to confirm the diagnosis and to prevent misleading inaccurate diagnoses.