Journal of the peripheral nervous system : JPNS
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Neurotoxic side effects of cancer therapy are second in frequency to hematological toxicity. Unlike hematological side effects that can be treated with hematopoietic growth factors, neuropathies cannot be treated and protective treatment strategies have not been effective. For the neurologist, the diagnosis of a toxic neuropathy is primarily based on the case history, the clinical and electrophysiological findings, and knowledge of the pattern of neuropathy associated with specific agents. ⋯ The neurologist managing the cancer patient who develops neuropathy must answer a series of important questions as follows: (1) Are the symptoms due to peripheral neuropathy? (2) Is the neuropathy due to the underlying disease or the treatment? (3) Should treatment be modified or stopped because of the neuropathy? (4) What is the best supportive care in terms of pain management or physical therapy for each patient? Prevention of toxic neuropathies is most important. In patients with neuropathy, restorative approaches have not been well established. Symptomatic and other management are necessary to maintain and improve quality of life.
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J. Peripher. Nerv. Syst. · Mar 2008
Comparative StudyHigh- and low-frequency transcutaneous electrical nerve stimulation delay sciatic nerve regeneration after crush lesion in the mouse.
The stimulation of peripheral nerve regeneration has been studied in different ways, including the use of electrical fields. The capacity of this modality to enhance nerve regeneration is influenced by the parameters used, including current type, frequency, intensity, and means of administration. Transcutaneous electrical nerve stimulation (TENS) is a frequently used form of administering electrical current to the body, but its effects on peripheral nerve regeneration are not known. ⋯ Electronmicrographs showed fewer and thinner thick myelinated fibers and increased number of Schwann cell nuclei. Myelinated axon diameters and density and diameter of nonmyelinated fibers were not affected by TENS, leading to the conclusion that this regimen of electrical stimulation leads to a delayed regeneration after a crush lesion of the sciatic nerve in the mouse. All these effects were more pronounced on high-frequency TENS nerves.
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J. Peripher. Nerv. Syst. · Dec 2007
Comparative StudyModulation of intracellular calcium influences capsaicin-induced currents of TRPV-1 and voltage-activated channel currents in nociceptive neurones.
Modulation of intracellular calcium ([Ca2+](i)) has a major impact on processing of nociceptive signals. While activation of the transient receptor potential vanilloid-1 (TRPV-1) receptor/channel complex increases [Ca2+](i) by Ca2+ entry from the extracellular space, as well as by Ca2+ release from intracellular stores, the Ca2+ entry through voltage-activated calcium channels (VACCs) is modulated simultaneously. To clarify the relations between [Ca2+](i) and the activation of TRPV-1 receptor and VACC currents [I(TRPV-1) and I(Ca(V))], we performed voltage clamp experiments using Ba2+ as well as Ca2+ as a charge carrier. ⋯ These currents were significantly different when Ca2+ was used as charge carrier: the I(Ca(V)) reductions were decreased to 17.8 +/- 5.9% of baseline, while the I(TRPV-1) was as high as 57.1 +/- 9.1% of I(Ca(V)). Increases of [Ca2+](i) by releasing Ca2+ from intracellular stores (using caffeine, 10 mM) before the application of capsaicin increased the I(TRPV-1) (14.1 +/- 7%), while the I(Ca(V)) was decreased to 51.6 +/- 4.9% compared with control. A preexperimental partial reduction of the Ca2+ release from the stores by dantrolene (5 microM) resulted in less pronounced effects [24.5 +/- 8.8%, relative to peak I(Ca(V))] for I(TRPV-1), and a reduction to 35.4 +/- 3% of baseline for I(Ca(V)) after capsaicin application.
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J. Peripher. Nerv. Syst. · Jun 2007
Proximal pain in patients with carpal tunnel syndrome: a clinical-neurophysiological study.
Patients with carpal tunnel syndrome (CTS) usually complain of pain and paresthesia in the hand or wrist, but pain proximally to the wrist has been frequently reported in this condition. This study was aimed at understanding which clinical features are associated with the presence of proximal pain (PP) in the upper limb of CTS patients. We recruited 250 patients with clinical and neurophysiological evidence of CTS. ⋯ PP may be found in a consistent number of CTS patients. PP may represent a clinical marker of mild median nerve damage. The presence of proximal complaints might be related to peripheral or central nervous system mechanisms.