S kemoterapijo povzročena periferna polinevropatija (CIPN) Chemotherapy induced peripheral nevropathy (CIPN)

Abstract

S kemoterapijo povzročena periferna polinevropatija (CIPN) je
disfunkcija perifernega živčevja kot posledica zdravljenja z enim
ali s kombinacijo več citostatikov. Najpogostejši povzročitelji
CIPN so taksani, derivati platine in vinka alkaloidi, njihovi vzročni
mehanizmi CIPN se razlikujejo in so vezani na njihovo cititoksično
aktivnost. CIPN se najpogosteje kaže s simptomatiko senzoričnega
sistema, redkejše so motorične motnje in motnje avtonomnega
živčnega sistema. Dejavniki tveganja za CIPN so splošni, ki jih
dobro poznamo in jih do določene mere lahko tudi zamejimo,
genetski dejavniki tveganja pa so aktualno predmet intenzivnih
raziskav. Patofiziološki procesi nastanka CIPN so delno poznani,
gre za več prekrivajočih se mehanizmov, ki povzročijo okvare na
nivoju živčnih končičev, aksonske okvare, motnje senzoričnih
ganglijev pa tudi okvaeo hrbtenjače. V patofiziološke mehanizme
nastanka CIPN se vpletajo tudi nevro-imunski procesi. Diagnoza
CIPN je klinična, v pomoč so lahko specifični vprašalniki za oceno
kvalitete življenja, objektivni metoda ocene CIPN je EMG. CIPN
ima praviloma reverzibilen potek, v posameznih primerih pa
ugotavljamo kronično ireverzibilno stanje. Za zdravljenje CIPN
uporabljamo v večji meri nefarmakološke ukrepe, v hujših primerih
pa tudi medikamentozno podporo z gabapentinom, pregabalinom
ter z amitriptilinom

Abstract (Eng)

Chemotherapy induced peripheral nevropathy (CIPN) is a dysfunction of the peripheral nervous system as a result of treatment with
one or a combination of several cytostatic agents. The most common
causative agents of CIPN are taxanes, platinum derivatives and
vinca alkaloids, their causative mechanisms of CIPN differ and are
related to their cytotoxic activity. CIPN is most often manifested
by the sensory symptoms, motor disorders and disorders of the
autonomic nervous system are rare. The risk factors for CIPN are
general, which we know well and can be limited to a certain extent,
while genetic risk factors are currently under intensive research.
The pathophysiological processes of the formation of CIPN are
partially known, they involve several overlapping mechanisms that
cause defects at the level of nerve endings, axonal defects, sensory
ganglia disorders, as well as spinal cord injury. Neuro-immune
processes are also involved. The diagnosis of CIPN is clinical,
specific questionnaires for semi-objective quality of life assessment
can be helpful, however the objective method of assessing CIPN is
EMG. As a rule, CIPN has a reversible course, but in individual
cases we find a chronic irreversible condition. For the treatment
of CIPN, non-pharmacological measures are mostly used, and in
severe cases also medical support with gabapentin, pregabalin and
amitriptyline can be beneficial.