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Related Concept Videos

Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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The Neuromuscular Junction01:19

The Neuromuscular Junction

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The nervous system consists of complex motor neuron circuits, including upper motor neurons originating from the cerebral cortex and lower motor neurons starting in the spinal cord, coordinating both voluntary and involuntary movements. Among these, somatic motor neurons activate skeletal muscles and are classified into alpha, beta, and gamma types. Alpha neurons are vital for voluntary movement coordination, while gamma neurons adjust muscle spindle sensitivity, and the function of beta...
19.3K
Integration of Synaptic Events01:28

Integration of Synaptic Events

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Synaptic integration mainly includes the summation of graded potentials. Graded potentials, regardless of their type, cause subtle alterations in membrane voltage, resulting in either depolarization or hyperpolarization. These incremental changes, when combined or summed, can propel the neuron toward its threshold. Consider, for example, a membrane experiencing a +15 mV shift, causing it to depolarize from -70 mV to -55 mV. In this scenario, graded potentials govern the membrane's ability to...
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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
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Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

806
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Neuromuscular Junction And Blockade01:29

Neuromuscular Junction And Blockade

5.1K
The site of chemical communication between a motor neuron and a muscle fiber is called the neuromuscular junction (NMJ). The end of the motor neuron at the NMJ divides into a cluster of synaptic end bulbs. The cytoplasm of these bulbs consists of synaptic vesicles enclosing acetylcholine molecules, the principal neurotransmitter released at the NMJ. The region opposite the synaptic bulb that ends in the muscle fiber is called the motor end plate, which has acetylcholine receptors. Within the...
5.1K

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Measuring Neuromuscular Junction Functionality
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[Neuromuscular Adverse Events].

Shigeaki Suzuki1

  • 1Dept. of Neurology, Keio University School of Medicine.

Gan to Kagaku Ryoho. Cancer & Chemotherapy
|July 26, 2018
PubMed
Summary

Immune checkpoint inhibitors (ICIs) can cause rare but serious neuromuscular adverse events (AEs) affecting the brain, nerves, and muscles. Early recognition and immune-modulating treatments are crucial for managing these potentially severe side effects in cancer patients.

Area of Science:

  • Oncology
  • Neurology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies.
  • Neuromuscular adverse events (AEs) are infrequent but serious complications of ICI treatment.
  • The diverse clinical presentations and underlying mechanisms of ICI-related neuromuscular AEs require elucidation.

Purpose of the Study:

  • To summarize the general features of neuromuscular AEs associated with ICIs.
  • To highlight the spectrum of central nervous system, peripheral nerve, neuromuscular junction, and muscle involvement.
  • To emphasize the importance of early diagnosis and management strategies for these AEs.

Main Methods:

  • Review of clinical presentations and characteristics of neuromuscular AEs in cancer patients treated with ICIs.

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  • Analysis of the frequency, affected systems, and clinical course of these events.
  • Discussion of the role of CD8+ cytotoxic T-cells and autoantibodies in pathogenesis.

    • Main Results:

    • Neuromuscular AEs affect 1-2% of patients on ICIs, involving diverse neurological systems.
    • Common mild AEs include headache, dizziness, and dysgeusia.
    • Serious AEs include autoimmune encephalitis, demyelinating polyneuropathy, myasthenia gravis, and myositis, often associated with myocarditis.

    Conclusions:

    • Neuromuscular AEs from ICIs can have rapid onset and critical courses, differing from non-drug-related conditions.
    • Withholding ICI therapy is recommended for significant neurological symptoms until diagnosis.
    • Immune-modulating therapies are generally effective, and understanding pathogenesis is key for optimal patient management.