Kissoon Trisha, Gururangan Sridharan, Sladky John
Department of Pediatrics, Hematology-Oncology, University of Florida, Gainesville.
Department of Neurosurgery, University of Florida, Gainesville.
Neurooncol Pract. 2019 May;6(3):179-184. doi: 10.1093/nop/npz002. Epub 2019 Mar 18.
Vincristine (VCR), a microtubule inhibitor that arrests the cell cycle by blocking metaphase of mitosis, is unique among the vinca alkaloids for causing polyneuropathy. Patients with increased risk of VCR neurotoxicity include the elderly and those with prior history of neuropathy-prone medical conditions. Identifying such risk factors prior to the development of neurotoxicity should be a goal prior to VCR administration. Clinicians should obtain a thorough medical and family history of neuropathies in any child scheduled to receive neurotoxic medications to avoid exacerbating an underlying disorder. We report a case of a young child with newly diagnosed medulloblastoma who started treatment on a VCR-containing chemotherapy regimen following surgery and craniospinal radiation. She subsequently developed severe peripheral polyneuropathy and new enhancement of the cranial and nerve roots following a relatively low cumulative dose of VCR and was diagnosed with previously unidentified Charcot-Marie-Tooth disease (CMTD) Type 1A. This case highlights that an evaluation of risk factors should be completed prior to initiation of neurotoxic chemotherapies and advocates for testing for inherited neuropathies such as CMTD even in asymptomatic patients when hereditary neuropathy is suspected.
长春新碱（VCR）是一种微管抑制剂，通过阻断有丝分裂中期来阻滞细胞周期，在长春花生物碱中，它是唯一会引起多发性神经病的药物。VCR神经毒性风险增加的患者包括老年人以及有易患神经病病史的人群。在神经毒性发生之前识别这些风险因素应该是使用VCR之前的一个目标。临床医生应该全面了解任何计划接受神经毒性药物治疗的儿童的神经病家族病史，以避免加重潜在疾病。我们报告了一例新诊断为髓母细胞瘤的幼儿病例，该患儿在接受手术和颅脊髓放疗后开始接受含VCR的化疗方案治疗。在相对较低的VCR累积剂量后，她随后出现了严重的周围性多发性神经病以及颅神经和神经根的新强化，并被诊断为先前未确诊的1A型遗传性运动感觉神经病（CMTD）。该病例强调，在开始使用神经毒性化疗之前应完成风险因素评估，并提倡即使在怀疑有遗传性神经病的无症状患者中，也要对CMTD等遗传性神经病进行检测。
