Falah Mohamed, Schiff David, Burns Ted M
Department of Neurology, University of Virginia, Charlottesville 22908, USA.
J Support Oncol. 2005 Jul-Aug;3(4):271-82.
Neuromuscular disorders are a common cause of morbidity in patients with cancer. They can be a direct effect of the primary malignancy, a paraneoplastic effect, or a treatment complication. Malignant neoplasms may infiltrate or compress nerve roots, plexi, and peripheral nerves, causing various sensory and motor symptoms. Electrodiagnostic testing, cerebrospinal fluid analysis, and neuroimaging are helpful in confirming the diagnosis. Treatment for neuropathies of neoplastic origin involves irradiation and chemotherapy, which may improve pain, but usually does not improve neurologic function. Paraneoplastic syndromes are rare and sometimes result from production of autoantibodies directed against neural antigens present in tumor tissues. They commonly precede any symptoms related to the cancer itself, and discovery of such syndromes necessitates a thorough investigation to look for an occult neoplasm. Treatment of the underlying cancer occasionally improves neurologic function. Both brachial and lumbosacral plexopathies may represent a complication of radiotherapy. Electrodiagnostic tests particularly are helpful; these diagnostics demonstrate the presence of myokymic discharges, which are suggestive of radiation injury. Many chemotherapeutic agents may cause peripheral neurotoxicity and associated acute and chronic peripheral neuropathies, particularly if given to patients with preexisting hereditary or acquired neuropathies. These side effects are a limiting factor in cancer treatment. Other potential neuromuscular problems related to cancer include side effects of steroids and other immunosuppressants, effects secondary to bone marrow transplantation, and infections. Early recognition and management of these disorders will improve patient outcome and quality of life.
神经肌肉疾病是癌症患者发病的常见原因。它们可能是原发性恶性肿瘤的直接影响、副肿瘤效应或治疗并发症。恶性肿瘤可能浸润或压迫神经根、神经丛和周围神经，导致各种感觉和运动症状。电诊断测试、脑脊液分析和神经影像学有助于确诊。肿瘤源性神经病变的治疗包括放疗和化疗，这可能会改善疼痛，但通常不会改善神经功能。副肿瘤综合征很少见，有时是由针对肿瘤组织中存在的神经抗原产生自身抗体引起的。它们通常先于任何与癌症本身相关的症状出现，发现此类综合征需要进行彻底检查以寻找隐匿性肿瘤。治疗潜在的癌症偶尔会改善神经功能。臂丛和腰骶丛神经病变都可能是放疗的并发症。电诊断测试尤其有用；这些诊断显示存在肌束震颤放电，提示放射损伤。许多化疗药物可能会导致周围神经毒性以及相关的急性和慢性周围神经病变，特别是给予已有遗传性或获得性神经病变的患者时。这些副作用是癌症治疗的一个限制因素。与癌症相关的其他潜在神经肌肉问题包括类固醇和其他免疫抑制剂的副作用、骨髓移植的继发效应以及感染。早期识别和处理这些疾病将改善患者的预后和生活质量。
