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Toxic neuropathies and myopathies
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-7519.
Abstract:
This review first considers toxic neuropathies of recent interest, including those caused by antineoplastic and antiretroviral drugs, agents that affect methylation reactions, vitamin and herbal preparations, and certain occupational exposures. The discussion points out the interesting phenomenon of "coasting," the strategy of using neurotrophic factors to combat toxic neuropathies, and the inapparent risks in "health foods." Second, it considers toxic myopathy syndromes, including zidovudine myopathy and its differentiation from HIV-associated inflammatory myopathy, cholesterol-lowering agent myopathies, acute myopathy with selective loss of myosin filaments due to neuromuscular blocking agents and corticosteroids, the eosinophilia myalgia syndrome, and colchicine myoneuropathy. Some of these syndromes illustrate important toxicologic principles about recognition of rare disorders, unanticipated temporal relationships with exposure, and risk factor assessment.
Insights
This review examines toxic neuropathies and myopathies from medications, occupational exposures, and supplements. It highlights neurotrophic factors for treatment and discusses recognizing rare toxic disorders.
Area of Science:
- Toxicology
- Neurology
- Pharmacology
Background:
- Toxic neuropathies and myopathies pose significant clinical challenges.
- Emerging concerns include drug-induced toxicities and occupational exposures.
- Understanding these conditions is crucial for patient safety and effective management.
Purpose of the Study:
- To review recent advances in understanding toxic neuropathies.
- To discuss various toxic myopathy syndromes and their underlying mechanisms.
- To highlight key toxicologic principles illustrated by these disorders.
Main Methods:
- Literature review of toxic neuropathies and myopathies.
- Analysis of drug-induced toxicities, including antineoplastic, antiretroviral, and cholesterol-lowering agents.
- Discussion of occupational exposures and herbal/vitamin preparations.
Main Results:
- Identified toxic neuropathies linked to specific drug classes and occupational exposures.
- Described various toxic myopathy syndromes, such as zidovudine myopathy and corticosteroid-induced myopathy.
- Highlighted the phenomenon of "coasting" in toxic neuropathies and the role of neurotrophic factors.
Conclusions:
- Toxic neuropathies and myopathies require careful recognition and risk assessment.
- Understanding temporal relationships and risk factors is essential for diagnosis and management.
- Neurotrophic factors show promise in combating toxic neuropathies.