Kandula Tejaswi, Farrar Michelle A, Kiernan Matthew C, Krishnan Arun V, Goldstein David, Horvath Lisa, Grimison Peter, Boyle Frances, Baron-Hay Sally, Park Susanna B
Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia.
Brain & Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Sydney, NSW, Australia.
Clin Neurophysiol. 2017 Jul;128(7):1166-1175. doi: 10.1016/j.clinph.2017.04.009. Epub 2017 Apr 25.
Chemotherapy induced peripheral neuropathy (CIPN) is a significant toxicity of cancer treatment, with the potential to affect long-term function and quality of life in cancer survivors. There remains a lack of consensus around optimal assessment techniques. While current approaches to CIPN assessment are focused on clinical grading scales, it is becoming increasingly evident that a more comprehensive multimodal assessment package is necessary to accurately characterise the impact of CIPN as well as gauge the utility of neuroprotective mechanisms. Neurophysiological techniques provide objective biomarkers and may enable early detection of toxicity while patient reported outcomes are necessary to determine the significance of symptoms to individual patients. In addition to providing an objective assessment, clinical neurophysiological techniques provide important insights into the contributory pathophysiological mechanisms of CIPN with different chemotherapy agents. There is a paucity of implementation of these techniques in the clinical trial setting. The present Review aims to facilitate the use of neurophysiological studies as part of comprehensive assessment packages for the monitoring of CIPN by summarising current understanding of neurophysiological changes that underlie the development of neuropathy, clinical presentations and patient reported outcomes as well as advantages and limitations of current techniques for the neurophysiological assessment of CIPN.
化疗引起的周围神经病变（CIPN）是癌症治疗的一种显著毒性反应，有可能影响癌症幸存者的长期功能和生活质量。目前对于最佳评估技术仍缺乏共识。虽然目前CIPN评估方法主要集中在临床分级量表上，但越来越明显的是，需要一个更全面的多模式评估方案，以准确描述CIPN的影响，并衡量神经保护机制的效用。神经生理学技术可提供客观的生物标志物，并可能实现毒性的早期检测，而患者报告的结果对于确定症状对个体患者的重要性是必要的。除了提供客观评估外，临床神经生理学技术还能深入了解不同化疗药物引起CIPN的病理生理机制。在临床试验环境中，这些技术的应用较少。本综述旨在通过总结目前对神经病变发展背后的神经生理学变化、临床表现、患者报告的结果以及当前CIPN神经生理学评估技术的优缺点的理解，促进将神经生理学研究作为CIPN综合评估方案的一部分用于监测。
