• Chemotherapy Tampa, Dr. Nelson Mane D.C. Tampa Florida, neuropathy tampa

    Posted on November 17th, 2010

    Written by Dr. Nelson Mañé

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    Previously, I have written regarding how little a diagnostic workup is generally done for patients suffering from peripheral neuropathy.  Although approximately 60 percent of diabetics have neuropathy, this does not imply that all neuropathy patients are diabetics.And it is certainly not the case that a patient with neuropathy who is not diabetic has neuropathy of unknown cause ( idiopathic neuropathy.) Yet this is what I see over and over again in my office. The patient will have had  basic  blood work ( CMP comprehensive  metabolic panel) that includes blood sugar and if that is okay, he is told he has idiopathic neuropathy.There are many other possible cause of neuropathy including conditions such as alcoholism, B vitamin deficiency, hypothyroid, kidney disease and autoimmune conditions to name a few. I recently had a patient who had been treated for throat cancer at a very prestigious cancer center in the northeast and presented to the office with neuropathy.One would assume that he had an extensive diagnostic work up and had failed standard treatments for neuropathy such as Neurontin, Lyrica and Cymbalta. He came to my office for high power laser therapy with which we have had considerable success in treating neuropathy. However, the treatments  always tend to have a higher success rate when the cause of the patients neuropathyhas been identified. Our laser protocol does fantastic work with neuropathy but if there is an ongoing cuase, it must be identified. And in fact, this patient had never been even been given a trial of Neurontin ( gabapentin) which typically is the first drug prescribed for neuropathy. This was very surprising. You see one can never assume anything. We discussed with the patient other possible cause including autoimmune dysregulation ( the appropriate blood work was ordered) and amino acid deficiency, particularly glutamine. This encounter is what prompted me to write this article so as to inform patients about another possible cause of neuropathy that they can discuss with their physcian. Patients with neuropathy are often times suicidal and looking under every rock for the cause of their symptoms is something they are entitled to. Glutamine is a relatively inexpensive amino acid and therefore realize that there is not much incentive from the large pharmaceutical companies to follow up and sponsor this type of research.

    Oral glutamine is effective for preventing oxaliplatin-induced neuropathy in colorectal cancer patients.

    Wang WS, Lin JK, Lin TC, Chen WS, Jiang JK, Wang HS, Chiou TJ, Liu JH, Yen CC, Chen PM.

    National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.

    Comment in:

    Abstract

    Oxaliplatin is effective in the treatment of metastatic colorectal cancer (MCRC) patients; however, severe neurotoxicity develops frequently. To assess the efficacy of oral glutamine for preventing neuropathy induced by oxaliplatin, a pilot study was performed. A total of 86 patients with MCRC treated at Taipei Veterans General Hospital were enrolled. Oxaliplatin (85 mg/m(2), days 1 and 15) plus weekly bolus 5-fluorouracil (5-FU; 500 mg/m(2)) and folinic acid (FA; 20 mg/m(2)) on days 1, 8, and 15 were given every 28 days as first-line treatment. Patients were randomized to receive (glutamine group; n = 42) or not receive (control group; n = 44) glutamine (15 g twice a day for seven consecutive days every 2 weeks starting on the day of oxaliplatin infusion). Efficacy of chemotherapy, neurological toxicity, and electrophysiological alterations were assessed. A lower percentage of grade 1-2 peripheral neuropathy was observed in the glutamine group (16.7% versus 38.6%) after two cycles of treatment, and a significantly lower incidence of grade 3-4 neuropathy was noted in the glutamine group after four cycles (4.8% versus 18.2%) and six cycles (11.9% versus 31.8%). By adding glutamine, interference with activities of daily living was lower (16.7% versus 40.9%), and need for oxaliplatin dose reduction was lower (7.1% versus 27.3%). There were no significant between-group differences in response to chemotherapy (52.4% versus 47.8%), electrophysiological abnormalities, grade 3-4 non-neurological toxicities (26.2% versus 22.8%), or survival. These data indi-cate that oral glutamine significantly reduces the incidence and severity of peripheral neuropathy of MCRC patients receiving oxaliplatin without affecting response to chemotherapy and survival.

    PMID: 17405895 [PubMed - indexed for MEDLINE]Free Article

    Clin Oncol (R Coll Radiol). 2005 Jun;17(4):271-6.

    Glutamine as a neuroprotective agent in high-dose paclitaxel-induced peripheral neuropathy: a clinical and electrophysiologic study.

    Stubblefield MD, Vahdat LT, Balmaceda CM, Troxel AB, Hesdorffer CS, Gooch CL.

    Department of Neurology, Rehabilitation Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York City, NY 10021, USA. stubblem@mskcc.org

    Abstract

    AIMS: The appearance of peripheral neuropathy is the dose-limiting toxicity in many chemotherapy protocols, and glutamine has been proposed as a potentially neuroprotective agent in patients receiving paclitaxel.

    MATERIALS AND METHODS: In this non-randomised study, we assessed neurologic signs and symptoms, and changes in nerve-conduction studies in 46 consecutive patients given high-dose paclitaxel either with (n=17) or without (n=29) glutamine. Neurological assessments and electrodiagnostic studies were carried out at baseline and at least 2 weeks (median 32 days) after treatment.

    RESULTS: Patients who received glutamine developed significantly less weakness (P = 0.02), less loss of vibratory sensation (P = 0.04) and less toe numbness (P = 0.004) than controls. The per cent change in the compound motor action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes after paclitaxel treatment was lower in the glutamine group, but this finding was not statistically significant in these small groups.

    CONCLUSIONS: In this study, serial neurologic assessment of patient symptoms and signs seemed to be a better indicator of a possible glutamine effect than sensory- or motor-nerve-conduction studies. Prospective randomised trials are needed to clarify the effect of glutamine on paclitaxel and other types of chemotherapy-induced neuropathy.

    PMID: 15997923 [PubMed - indexed for MEDLINE

    Support Care Cancer. 2006 May;14(5):484-7. Epub 2006 Feb 1.

    N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data.

    Lin PC, Lee MY, Wang WS, Yen CC, Chao TC, Hsiao LT, Yang MH, Chen PM, Lin KP, Chiou TJ.

    Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan, Republic of China.

    Abstract

    Although adding oxaliplatin to fluorouracil and leucovorin in adjuvant chemotherapy for colon cancer may improve disease-free survival, grade 3-4 sensory neuropathy also increases. To determine whether oral N-acetylcysteine is neuroprotective against oxaliplatin-induced neuropathy, we did a pilot study. Fourteen stage III colon cancer patients with 4 or more regional lymph nodes metastasis (N2 disease) receiving adjuvant biweekly oxaliplatin (85 mg/m(2)) plus weekly fluorouracil boluses and low-dose leucovorin were randomized to oral N-acetylcysteine (1,200 mg) (arm A) or placebo (arm B). Clinical neurological and electrophysiological evaluations were performed at baseline and after 4, 8, and 12 treatment cycles. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) Criteria. After four cycles of chemotherapy, seven of nine patients in arm B and two of five in arm A experienced grade 1 sensory neuropathy. After eight cycles, five experienced sensory neuropathy (grade 2-4 toxicity) in arm B; none in arm A (p<0.05). After 12 cycles, grade 2-4 sensory neuropathy was observed in eight patients in arm B, one in arm A (p<0.05). There were no significant electrophysiological changes in arm A after 4, 8, or 12 cycles of chemotherapy. We concluded that oral N-acetylcysteine reduces the incidence of oxaliplatin-induced neuropathy in colon cancer patients receiving oxaliplatin-based adjuvant chemotherapy.

    PMID: 16450089 [PubMed - indexed for MEDLINE]

    This entry was posted on Wednesday, November 17th, 2010 at 8:55 pm and is filed under Chemotherapy Tampa, Dr. Nelson Mane D.C. Tampa Florida, neuropathy tampa. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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