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Abstract:
Five patients developed a mild to severe polyneuropathy while under treatment with perhexiline maleate, a drug used in long-term treatment of angina pectoris. Recovery took place within a few months after drug withdrawal. We performed qualitative and quantitative light and electron microscopical studies, including teased fiber preparations, in different patients; 16 to 90% of the fibers showed segmental demyelination, an unusual feature in drug-induced neuropathies, and 3 to 20% were undergoing wallerian degeneration. Severe loss of myelinated axons was noted in all 5 patients. In these patients clinical symptoms occurred only when a great number of fibers had already been lost and most of the surviving fibers showed demyelination.
Insights
Perhexiline maleate, used for angina, can cause polyneuropathy. This nerve damage, characterized by demyelination and axon loss, reversed after discontinuing the drug.
Area of Science:
- Neurology
- Toxicology
- Pathology
Background:
- Perhexiline maleate is a medication for angina pectoris.
- Drug-induced neuropathies are a known concern in clinical practice.
Purpose of the Study:
- To investigate the neuropathological effects of perhexiline maleate.
- To characterize the histological features of perhexiline-induced polyneuropathy.
Main Methods:
- Light and electron microscopy were used for qualitative and quantitative analysis.
- Teased fiber preparations were utilized to examine nerve fiber pathology.
- Histopathological examination of nerve biopsies from affected patients.
Main Results:
- Five patients developed mild to severe polyneuropathy during perhexiline maleate treatment.
- Histological findings included segmental demyelination (16-90% of fibers) and Wallerian degeneration (3-20% of fibers).
- Severe loss of myelinated axons was observed in all patients; clinical symptoms correlated with significant fiber loss and demyelination.
Conclusions:
- Perhexiline maleate can induce a significant polyneuropathy characterized by demyelination and axon loss.
- Nerve damage is reversible upon drug withdrawal, with recovery occurring within months.
- The study highlights the importance of monitoring for neurological side effects during long-term perhexiline maleate therapy.