Characteristics Of The Electromyography Of Peripheral Neuropathy Caused By Oxaliplatin

Objective:To study the characteristics of nerve electromyography in patients with gastroenterology cancer, who received oxaliplatin and leucovorin calcium solution(called FOLFOX chemotherapy regimens) and further developed peripheral neuropathy caused by this regimens.To discuss the relationships between the grading of peripheral nerve toxicity reaction and electromyogram features caused by OXA and OXA accumulated dose.Methods:We prospectively collected the colorectal cancer patients admitted into hospital who would accept FOLFOX regimens chemotherapy firstly. Before the first chemotherapy, every subject was given the nerve conduction studies, the results of which were regarded as the characteristics of the before chemotherapy group. Those patients appearing peripheral neuropathy gradually after the chemotherapy consisted the as after the chemotherapy group. During the procedure of chemotherapy, we recorded the clinical feature of patients and toxic grading(according the convention toxic standard formulated by the US national cancer research) of peripheral neuropathy after each cycle of chemotherapy. When the symptoms of neurotoxicity aggravated and developed to higher levers, patients would undergo the EMG test. Finally, we compare the differences of EMR nerve conduction manifestation between the patients before chemotherapy and ones after chemotherapy who appeared peripheral neuropathy and then compare the each level differences of EMR nerve conduction manifestation of ones after the chemotherapy group.In the second place,to analysis the relationships between the clinical classification, EMR manifestations and the accumulated dose of OXA were investigated in this study.Results:1.we collected 70 qualifying cases from the the department of medical oncology in General Hospital of Beijing Military Region from January 2014 to December 2014, among them 14 cases were in the before chemotherapy group(no peripheral neuropathy group), and the other 56 cases were in after the chemotherapy group(peripheral neuropathy group), 24 cases(42.86%) were degreeⅠ;26 cases(46.43%) were degree II;5 cases(8.93%%) were degree III and 1 cases(8.93%%) were degree IV(1.78%).2.The clinical features of peripheral neuropathy caused by OXA are as following :all of the56 cases of an after the chemotherapy group had numbness of terminal nerve in distal limbs; 30cases(53.57%) occured electrical sensation; 23 cases(41.07%) occurred weakness; 39 cases(69.64%) occured limbing or disappearing of tendon reflex; 27 cases(48.21%) experienced decreasing or absent pinprick sensation; 23 cases(41.07%) suffered reducing or absent vibratory sense; small number of patients faced pain, burning sensation, hyperesthesia or disappearing of tactus and loss of limb muscle strength.3.The relationship between toxicity grading and accumulated dose of OXA: the average dose of peripheral neuropathy degree I/II/III/V was 458.83±218.87mg/m2,741.68±193.86mg/m2,1014.00±105.25mg/m2,1034mg/m2,respectively.4.The EMR manifestation of an after the chemotherapy group: among 56 cases of an after the chemotherapy group, there were 51 cases(91.07%) that occured the abnormal ERM,including 19 cases(37.25%) were degreeⅠ, 26 cases(50.98%) were degreeⅡ, and 5 cases(9.81%%)were degree III and 1 cases(1.96%) were degree IV. The EMR manifestations were the latency of all levels of sensory nerve showed a trend of increasing step by step, along with the increase of nerve toxicity, but amplitude,conduction velocity showed a trend of decreasing step by step,and the difference of Each nervea mplitudewas statistically significant(P<0.05). At the same time, the latency of all levels of nervus motorius showed a trend of increasing step by step, along with the increase of nerve toxicity, but amplitude, conduction velocity showed a trend of decreasing step by step, but there was no statistically significant difference(P>0.05).5. The comparison of EMR manifestation between an after the chemotherapy group and the before chemotherapy group: in an after the chemotherapy group the latency of motorius conduction potential was longer than the control group, meanwhile amplitude decrease, sensory conduction potential was longer than the control group, meanwhile amplitude decrease, conduction vel-ocity slow down. The differences of the conduction potential amplitude of nervus motorius like the right side of the each section median nerve, the right side elbow-wrist of ulnar nerve distal were statistically significant(P<0.05). In addition, there were also statistically differences of the conduction potential amplitude and conduction velocity of sensory between nervus like the right side of the median nerve, ulnar nerve, left and right posterior tibial nerve(P<0.05).To compare with the before chemotherapy group,the average latency of F-wave and latency of F-M in an after the chemothe- rapy was longer than the before chemotherapy group, but the two group of Fwave was no statis- tically significant difference(P>0.05).6.The comparison of EMR abnormal rate between upper and lower limbs:comparison among groups of the motor conduction potential was no statistically significant difference(P>0.05),comparison among median nerve with ulnar nerve of the motor conduction potential was no statistically significant difference, but they compare with posterior tibial nerve respectively was statistically significant difference(P<0.05).Conclusions:1.OXA can lead to peripheral neuropathy, and the clinical manifestations were mainly disturbance of distal limb sensory;2.OXA can damage the conduction potential of nervus motorius and sensory nerve of the right side of the median nerve, ulnar nerve and posterior tibial nerve. The manifestations were as the longer latency, decreasing amplitude, slowing conduction velocity and declining occurrence rate of F-wave.The main damage is the injury of sensory nerve, which can be used as an objective and accurate evaluation of the neurotoxicity of OXA.3. The EMR manifestation of peripheral neuropathy caused by oxaliplatin were mainly the injury of distal sensory nerve axonal, along with mild injury of the motor nerve,and injury of the proximal median nerve and proximal posterior tibial nerve.4.Oxaliplatin into neurotoxicity in upper limb injury.5.Both clinical grading of neurotoxicity caused by oxaliplatin and the abnormality of EMR were significantly associated with accumulative OXA dose.