What are the symptoms of a chemotherapy-induced polyneuropathy?

Symptoms of a chemotherapy-induced polyneuropathy are usually symmetrical, both on the left and on the right hands and feet. A distinction is made between sensory and motor symptoms.

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Sensory symptoms

Sensory symptoms in particular are very varied.Patients often describe

• Hypersensitivity
• Sensations such as tingling or “formication”
• pain
• numbness
• Disturbances in the perception of temperature and vibrationin the hands and feet.

Although these symptoms are not life-threatening, they are perceived as unpleasant and disturbing. However, some sensory disorders are dangerous: Numbness can cause fine motor problems in everyday life. This can lead to difficulties with writing, balance problems and falls. In addition, the numbness means that superficial injuries often go unnoticed, increasing the risk of wound infection.

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Motor symptoms

Motor symptoms occur much less frequently. They are manifested by weakened muscle reflexes, reduced muscle strength with possible limitations in the ability to walk and stand, involuntary muscle twitching and muscle cramps.Visual disturbances or hearing and balance disorders can also occur due to functional impairments of the cranial nerves.

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Risk factors of chemotherapy-induced polyneuropathy

The likelihood of suffering from symptoms of CIPN has been observed to increase in patients receiving platinum derivatives, taxanes, vinca alkaloids, eribulin, bortezomib or thalidomide as chemotherapeutic agents.In addition, CIPN is also favored by the following factors:

• Diabetes mellitus
• renal insufficiency
• HIV infection
• hypothyroidism
• genetic factors (CMT gene mutation)
• specific rheumatic and autoimmune diseases (collagenoses/vasculitides)
• high alcohol consumption
• vitamin deficiency
• older than 75 years

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Chemotherapy-induced polyneuropathy: prevention and treatment options

If chemotherapy is necessary, preventive measures can help to reduce side effects such as polyneuropathy.

For example, regular functional training is currently recommended at the start of treatment. Functional training includes various physical activities such as endurance training, weight training, balance training and yoga. Drug prophylaxis is not currently recommended.

Pay particular attention to your body during therapy. If the first symptoms occur, discuss them with your therapist. Depending on the symptoms, their occurrence, frequency and severity, a reassessment of chemotherapy may be appropriate: Treating physicians usually weigh up the benefits and risks of certain types of therapy and review the dosage and frequency of chemotherapy. Other therapeutic measures, i.e. a change of therapy to another drug, may also be considered.

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No drug is currently approved for the medical treatment of chemotherapy-induced polyneuropathy. In the guidelines, however, experts give a moderate recommendation for the drug duloxetine, which can alleviate the pain. Antidepressants and anticonvulsants or antiepileptics (e.g. amitriptyline, venlafaxine, gabapentin, pregabalin) can also be considered. Antiepileptic drugs act against muscle spasms, among other things. Opioids and also specific patches and ointments for pain can also be considered.

Sports and physiotherapy are recommended for the treatment of chemotherapy-induced polyneuropathy - similar to prevention. Occupational therapy and electrotherapy can also reduce symptoms. Measures are often aimed at the following areas:

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• Sensorimotor training
• Coordination training
• Vibration training
• Fine motor training
• Endurance training
• Walking and standing training
• Tai Chi

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These therapies can improve dexterity, balance and mobility. The risk of falling is reduced. Other side effects such as fatigue are also reduced.

Furthermore, small adjustments in everyday life can provide relief. Sturdy shoes or a walking aid can provide good stability. Conscious hand and foot care also protects against injuries and infections.