Efficacy of Exercise Rehabilitation Program in Relieving Oxaliplatin Induced Peripheral Neurotoxicity.

BACKGROUND: Peripheral neurotoxicity is common in patients with digestive malignancies receiving chemotherapy containing oxaliplatin, and there is still no effective drug to prevent or treat this complication. METHODS: Seventy-nine patients receiving chemotherapy containing oxaliplatin were included, and the relationship between chemotherapy regimens, cycles, and cumulative dose of oxaliplatin and peripheral neurotoxicity was analyzed. Patients were divided into two groups of control or intervention. Twenty-eight patients in the control group received routine chemotherapy care, and 51 patients in the intervention group underwent two-week exercise rehabilitation program. Patients' Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity (FACT/GOG-Ntx), functional tests, and Brief Pain Inventory(BPI) scores as well as interference life scores were assessed before intervention and two weeks after the intervention. RESULTS: In the intervention group, 52.9% patients previously exercised regularly. The FOLFOX regimen was more common in peripheral neurotoxicity (73.4%), and the median oxaliplatin cycles for neurotoxicity was 9 (ranging from 1 to 16). The mean cumulative dose of oxaliplatin was 1080.02 ± 185.22 mg, both the cycles and cumulative dose were positively correlated with the occurrence of peripheral neurotoxicity. Compared with control, the scores of FACT/GOG-Ntx, functional tests, and BPI were significantly decreased in the intervention group (p < 0.05). CONCLUSION: Chemotherapy cycles and cumulative doses were in relation with OIN  , and exercise rehabilitation program could effectively alleviate OIN.
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The Effect of Therapeutic Exercises on Balance, Quality of Life, and Pain in Patients Who Were Receiving Neurotoxic Chemotherapy.

OBJECTIVE: The aim of the study was to evaluate the effect of lower limb strengthening and balance exercises on balance, quality of life and neuropathic pain of the cancer patients receiving neurotoxic chemotherapy. DESIGN: Patients who were planning to receive neurotoxic chemotherapy agents were included in the first group. They were trained before the neurotoxic chemotherapy sessions with the 10-wk home-based exercise program including lower limb strengthening and balance exercises. The second group of patients who had received the third cycle of neurotoxic chemotherapy had no exercise program. Both groups were evaluated after the third cycle. Neurocom Balance Master and Berg Balance Scale were used to evaluate balance. The neuropathic pain was questioned by PainDETECT questionnaire and the quality of life was assessed with the European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire. RESULTS: Sixty patients were admitted to this study. Twenty-four patients were in the exercise group (F = 14, M = 10) and 36 patients were in the control group (F = 17, M = 19). Sociodemographic and clinical data of both groups were similar. Berg Balance Scale (P = 0.005), European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire global quality of life, physical function, and emotional status were higher, and symptom scores and PainDETECT questionnaire score were lower in the exercise group (P < 0.05). Balance tests were different between the groups. CONCLUSIONS: Strengthening and balance exercises have a valuable effect on balance, quality of life, and neuropathic pain in patients receiving neurotoxic chemotherapy.

Short-Term Recovery of Balance Control: Association With Chemotherapy-Induced Peripheral Neuropathy in Pediatric Oncology.

PURPOSE: To describe the incidence and short-term recovery of balance control in children and adolescents receiving neurotoxic treatment for noncentral nervous system cancers and to investigate the association of chemotherapy-induced peripheral neuropathy and balance control. METHODS: Sixty-five children and adolescents diagnosed with leukemia, lymphoma, or other solid tumors were tested 3 to 6 months into treatment and 3 and 6 months following treatment using the Bruininks-Oseretsky Balance Subscale and Pediatric Modified Total Neuropathy Scale scores of chemotherapy-induced peripheral neuropathy (CIPN). RESULTS: Seventy-eight percent of the participants scored 1 standard deviation or more below population means on the balance subscale while on treatment, and this improved to 53% by 6 months posttreatment, with the leukemia group performing worse at both time points. On-treatment balance scores were moderately associated with motor CIPN, while at 6 months posttreatment they were more closely associated with sensory CIPN. CONCLUSIONS: Mild to moderate balance impairments improve but can persist, even when CIPN has improved, 6 months after treatment for childhood cancer.

[Dynamics of eeg and psychophysiological indicators of acute poisoning neurotoxicants on the stage of rehabilitation on the background of different methods of treatment]. / Dinamika elektroentsefalograficheskikh i psikhofiziologicheskikh pokazatelei pri ostrykh otravleniyakh neirotoksikantami na etape reabilitatsii na fone razlichnykh metodov lecheniya.

AIM: To evaluate the dynamics of functional activity of brain structures underlying cognitive functions in patients with encephalopathy due to poisoning with neurotoxicants on the stage of rehabilitation. MATERIAL AND METHODS: Fifty-six patients were examined. The main group consisted of 40 patients treated with intravenous injections with mexidol (n=10), combination of mexidol with non-pharmacological methods - mesodiencephalic modulation (MDM) (n=10), hyperbaric oxygenation (HBO) (n=10) and the combination of MDM and HBO (n=10). The comparison group included 16 people. All patients underwent neurophysiological (EEG, auditory event-related potentials) and neuropsychological examinations. RESULTS: Marked EEG changes were noted in all patients. The domination of disturbances of functional activity on the diencephalic or mesodiencephalic levels was observed. After treatment, positive changes were found in 60% of patients. The positive dynamics was observed in 80% patients when the combination of mexidol, MDM and HBO was used. The negative dynamics was noted in 5 (12,5%) of patients of the main group, in particular when mexidol only was used. The results of the primary neuropsychological study revealed that cognitive impairment of different severity was found in 97,5% of patients of the main group and 100% of patients of the comparison group. After treatment, performance on neuropsychological tests improved by 62,5%, N200 and P300 latencies reduced, while the amplitudes increased, in the patients of the main group. CONCLUSION: The use of mexidol, MDM and HBO in the treatment of patients with encephalopathy due to poisoning with neurotoxicants on the stage of rehabilitation improved the indicators of functional brain activity and cognitive functions.

[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

Pepto bismuth associated neurotoxicity: A rare side effect of a commonly used medication.

A 56 years old female with medical history significant for collagenous colitis and GERD for which she was taking Pepto Bismuth for months. She presented with progressive confusion for two weeks, followed by myoclonus, tremors, gait instability and visual hallucinations. Patient was admitted and comprehensive work up was done over a ten day course. This included a CBC, CCP CT head, MRI brain, EEG, Lumbar puncture, and various antibody and serology testing which were all essentially unremarkable. It was noted that patient had been taking OTC Pepto Bismuth chronically for GI symptoms. Based upon the unrevealing work up, serum and urine samples for Bismuth levels were sent and returned markedly positive in both samples. Bismuth was held on admission and over the ten day hospitalization, patient showed gradual improvement of her cognitive function. She also showed resolution of her abnormal movements, myoclonus and visual hallucinations. Her gait continued to improve and required extended period of physical therapy post discharge. Her subsequent follow up visits showed resolution to baseline at four months post discharge.

A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy.

Chemotherapy-induced peripheral neuropathy (CIPN) results from damage to or dysfunction of the peripheral nerves. The development of CIPN is anticipated for the majority of breast cancer patients who receive neurotoxic chemotherapy, depending on the agent used, dose, and schedule. Sensory symptoms often predominate and include numbness, tingling, and distal extremity pain. Weakness, gait impairment, loss of functional abilities, and other deficits may develop with more severe CIPN. This article outlines a prospective surveillance model for physical rehabilitation of women with breast cancer who develop CIPN. Rehabilitative efforts for CIPN start at the time of breast cancer diagnosis and treatment planning. The prechemotherapy evaluation identifies patients with preexisting peripheral nervous system disorders that may place them at higher risk for the development of CIPN. This clinical evaluation should include a history focusing on symptoms and functional activities as well as a physical examination that objectively assesses the patient's strength, sensation, reflexes, and gait. Ongoing surveillance following the initiation of a neurotoxic agent is important to monitor for the development and progression of symptoms associated with CIPN, and to ensure its resolution over the long term. CIPN is managed best by a multidisciplinary team approach. Early identification of symptoms will ensure appropriate referral and timely symptom management. The prospective surveillance model promotes a patient-centered approach to care, from pretreatment through survivorship and palliative care. In this way, the model offers promise in addressing and minimizing both the acute and long-term morbidity associated with CIPN.

Un enfoque de terapia ocupacional adaptada a la rehabilitación cognitiva de los efectos cognitivos colaterales asociados a la quimioterapia en pacientes supervivientes de cáncer de mama: dos estudios de mujeres postmenopáusicas afectadas / A tailored occupational therapy approach to cognitive rehabilitation of chemotherapy-related cognitive side effects in breast cancer survivors: Two case stuidies of prmenopausally affected women

This article describes a tailored occupational therapy program to rehabilitate chemotherapy-related cognitive side effects. A literature review of cognitive rehabilitation as well as pharmacological trials used to improve cognition in breast cancer patients is included. Two outpatient case studies of young women premenopausally affected with breast cancer (both BRCA-1 gene mutation carriers) are used to discuss the role of tailored occupational therapy techniques for developing compensatory strategies and for delivering cognitive remediation. Neuropsychological evaluation pre and post occupational therapy is used to document the result of tailored occupational therapy on cognitive performance. The case studies illustrate the neuropsychological profile of chemotherapy-related cognitive changes and the course of deficits over 7-9 months. For younger, educated patients who must return to competitive, fast-paced jobs, cognitive side-effects post-treatment are especially noxious as young adult patients are building their professional lives and are not necessarily provided time to wait for the usual trajectory of recovery to take its course (AU)

En este artículo se describe un programa de terapia ocupacional adaptado para rehabilitar los efectos cognitivos secundarios asociados a la quimioterapia. Se incluye una revisión de la literatura de la rehabilitación cognitiva, así como de los ensayos farmacológicos utilizados para mejorar la cognición en pacientes de cáncer de mama. Se exponen dos estudios de caso ambulatorios de mujeres jóvenes premenopáusicas afectadas de cáncer de mama (ambas portadoras de mutaciones del gen BRCA-1) para examinar la función de técnicas de terapia ocupacional adaptadas para el desarrollo de estrategias compensatorias y para administrar rehabilitación cognitiva. La evaluación neuropsicológica antes y después de la terapia ocupacional se utiliza para documentar el resultado de la terapia ocupacional adaptada para el rendimiento cognitivo. Los estudios de casos ilustran el perfil neuropsicológico de los cambios asociados a la quimioterapia y el curso de los déficits durante 7-9 meses. En los pacientes jóvenes, con estudios que deben retornar a puestos de trabajo de ritmo rápido y competitivos, los efectos cognitivos secundarios postratamiento son especialmente nocivos, ya que los pacientes jóvenes adultos están construyendo sus vidas profesionales y no disponen del tiempo necesario de espera para que la trayectoria habitual de recuperación siga su curso (AU)

Psychosocial and cognitive rehabilitation of patients with solvent-induced chronic toxic encephalopathy: a randomised controlled study.

BACKGROUND: There is little experience with the (neuro) psychological treatment of patients with solvent-induced chronic toxic encephalopathy (CSE). In this randomised controlled trial (RCT), a treatment programme was evaluated based on previous outcome studies of patients with chronic fatigue, whiplash and traumatic brain damage. METHODS: The treatment consisted of 8 group sessions based on cognitive behavioural principles focusing on inadequate illness behaviours, and 8 sessions of cognitive strategy training to compensate memory problems. The research design was an RCT with follow-up, comparing the cumulative effect of the 2 interventions allocated in random order with a waiting-list control group. Outcome measures were treatment satisfaction, self-ratings of psychosocial and cognitive changes, psychosocial and memory questionnaires and neuropsychological tests. Multiple linear regression analyses were performed with baseline scores, treatment versus control condition, effort status, and litigation or financial compensation status as predictors. RESULTS: Ninety-five patients started treatment, 84 patients had complete data. Treatment satisfaction was high. After the treatment, only the treatment group had improved on objective memory tests and on complaints related to CSE, but not on other questionnaires. Treatment effects diminished at follow-up. Insufficient effort and litigation were negatively associated with treatment outcome. CONCLUSIONS: The positive treatment effects on the cognitive tests were only temporary. It might be important to study the effect of booster sessions to update practiced cognitive strategies. Effort was an important predictor of success, more important than involvement in a litigation procedure. This finding should have implications for the selection of patients.

Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use.

Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and/or become addicted to only one substance, generally alcohol or heroin. Heroin addicts were recruited from an inpatient treatment facility in St. Petersburg. Three comparison groups included alcoholics, addicts who used both alcohol and heroin, and non-abusers. Psychiatric, background, and drug history evaluations were administered after detoxification to screen for exclusion criteria and characterize the sample. Executive Cognitive Functions (ECF) that largely activate areas of the prefrontal cortex and its circuitry measured include complex visual pattern recognition (Paired Associates Learning), working memory (Delayed Matching to Sample), problem solving (Stockings of Cambridge), executive decision making (Cambridge Decision Making Task), cognitive flexibility (Stroop Color-Word Task) and response shifting (Stop Change Task). In many respects, the heroin addicts were similar to alcohol and alcohol+heroin dependent groups in neurocognitive deficits relative to controls. The primary finding was that heroin addicts exhibited significantly more disadvantageous decision making and longer deliberation times while making risky decisions than the other groups. Because the nature and degree of recovery from drug abuse are likely a function of the type or pattern of neurocognitive impairment, differential drug effects must be considered.

[Transcranial electrical stimulation in the treatment of toxicohypoxic encephalopathy at the early stage of inpatient rehabilitation].

The authors studied the time course of clinical and neuropsychological changes in the use of transcranial mesodiencephalic modulation in the complex treatment of patients with acute poisoning by neurotropic toxicants, which were complicated by toxicohypoxic encephalopathy. The findings suggest the beneficial impact of this technique on the autonomic functions of the brain stem, on the body's adaptive capacities and the psychoemotional sphere, which makes it possible to recommend the programmed use of this method in such patients.

Successful treatment of hydromorphone-induced neurotoxicity and hyperalgesia.

There has been an increase in opioid consumption world wide in the last decade. There has also been a disturbing increase in the number of reports of neuroexcitatory opioid-related side effects observed in patients receiving large doses of systemically administered morphine and its structural analogue, hydromorphone. It is now becoming clearer that patients receiving long-term opioid therapy can develop unexpected pain. We describe an interesting case of successful management of hydromorphone-induced neurotoxicity and hyperalgesia produced by short-term therapy with rapidly escalating doses of systemic hydromorphone.