Thalidomide neuropathy: An electrophysiologic study

Abstract

Thalidomide is effective in the treatment of such disabling dermatologic diseases as aphthosis, discoid lupus erythematosus, and prurigo nodularis, in which other drugs fail. However, its use can induce neuropathy necessitating caution in its administration. It was found in this electrophysiologic study of 13 patients that the data best revealing neuropathy, even when clinical abnormalities were not apparent, were reduction of sensory nerve action potential amplitude on the sural nerve, increase of somatosensory evoked potential latency following sural nerve stimulation, and reduction of sensory action potential amplitude on stimulating the median nerve at the wrist. In two patients, electrophysiologic abnormalities had increased after withdrawal, suggesting a prolonged action of thalidomide. Timely reduction of dosage, after detection of changes indicating the onset of side effects, could reduce the risk of the sometimes rapid emergence of clinical symptoms.

Thalidomide Treatment for Prurigo Nodularis in Human Immunodeficiency Virus –Infected Subjects

“…As in previous reports, 16,19,27,42,43 the sural SNAP amplitude was the most sensitive neurophysiologic marker of TPN in our study. When the sural response was absent at baseline, we relied on symptoms and the NIS.…”

“…Increased age is suggested as a predisposing factor 42 but was not observed in our study or the study by Basturi-Garin et al 20 Incomplete improvement of the neuropathy with termination of thalidomide treatment supports the view that TPN is a neuronopathy. 18,19,27,43 None of our subjects was disabled by residual neuropathy. Thalidomide can be successfully restarted or reduced without progression of TPN.…”

“…[16][17][18][19]42,43 Motor findings and painful dysesthesias are described with prolonged use, which were likely prevented in our cohort by careful monitoring and rapid adjustment of thalidomide dosing with the onset of TPN. 17 The acute onset of symptoms and signs followed by stabilization or improvement of neuropathy with reduction in thalidomide dosage enabled distinction of TPN from AIDS neuropathy.…”

Long-term thalidomide use in refractory cutaneous lesions of systemic lupus erythematosus

“…However, weakness and signs of pyramidal tract involvement may occur. Sensory symptoms may persist, and sometimes get worsen, after withdrawal of the drug and the pathologic findings suggest axonal neuropathy 34 . Although the frequency and the severity of neuropathy are not always found to be related to total dosage 34 , Wulff et al, confirmed that the neuropathy began after a total of 40-50g of thalidomide in most patients 35 .…”

Thalidomide for the Treatment of Refractory Necrobiosis Lipoidica

“…Electrophysiologic findings include a sensory axon polyneuropathy with a sensory nerve action potential (SNAP) amplitude decrease. A 50% decrease in SNAP amplitude is closely related to clinical signs and symptoms 7,8 Therefore, it is recommended that baseline nerve studies be performed in all patients who receive thalidomide within 3 months of initiating therapy and every 6 months thereafter. With a decrease in SNAP of greater than 30%, more frequent testing is recommended, and thalidomide therapy should be discontinued if the SNAP decreases by more than 50% until the peripheral neuropathy resolves.…”