Electrophysiological findings in immune checkpoint inhibitor-related peripheral neuropathy |
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Authors: | Xi Chen Aya Haggiagi Efstathia Tzatha Lisa M DeAngelis Bianca Santomasso |
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Institution: | 1. Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA |
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Abstract: | ObjectiveTo report the electrodiagnostic features of immune checkpoint inhibitor (ICI)-related neuropathy.MethodsWe retrospectively reviewed clinical presentations and electrodiagnostic features of 23 patients studied after receiving immune checkpoint inhibitors (ICIs). The presentations for electrodiagnostic evaluation included an acute neuropathy or neuromuscular junction disorder. We applied established electrodiagnostic criteria for polyneuropathy and acute demyelinating neuropathy.ResultsWe identified acute demyelinating neuropathy (13 cases), axonal sensory motor neuropathy (5), pure sensory neuropathy (4) and mononeuropathy (1). 13 patients had acute demyelinating neuropathy confirmed by demonstrating demyelination in 2 or more nerves; 3 additional patients had demyelination in only one nerve. Analysis of motor nerve conduction parameters revealed demyelination involving median and ulnar nerve distal motor latencies as well as median, ulnar and peroneal nerve conduction velocities. Conduction block was found in median, ulnar and peroneal nerves. The remaining one-third patients without demyelination had acute painful axonal neuropathy. Coexisting myopathic changes (6) and neuromuscular junction dysfunction (4) were also identified.ConclusionsOur findings suggest that, while immune-mediated motor nerve demyelination is the primary underlying mechanism of ICI-related neuropathy, axonal painful neuropathy can also be an important presentation. Early recognition and effective intervention may reduce morbidity and permanent disability.SignificanceElectrophysiological studies might be useful in the evaluation of ICI-related neuropathy. |
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Keywords: | Corresponding author at: Department of Neurology Memorial Sloan Kettering Cancer Center New York NY 10021 USA Immune checkpoint inhibitor Immune-mediated polyneuropathy Acute demyelinating polyradiculoneuropathy Electrophysiological study ICI immune checkpoint inhibitor PD1 programmed cell death protein 1 PD-L1 programmed cell death protein 1 ligand CTLA4 Cytotoxic T-lymphocyte associated protein 4 irAE immune-related adverse effect AIDP acute inflammatory demyelinating polyradiculoneuropathy GBS Guillain-Barré syndrome CIDP chronic inflammatory demyelinating polyneuropathy CMAP compound muscle action potential SNAP sensory nerve action potential CTCAE common terminology criteria for adverse events |
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