Toxic neuropathies

Current publications describe neurotoxic effects of metals, pharmaceutical products, and environmental, biological and experimental substances. Agents such as lead remain the object of new epidemiological methods to identify victims. The use of methylcobalamin to ameliorate acrylamide toxicity is being explored. Antiarrhythmic and antilipidemic drugs continue to be associated with neuropathic effects but appear to be amenable to adjustments in dosage. To help control the neurotoxic effects of the chemotherapeutic drugs taxol and cisplatin analogs of adrenocorticotropic hormone and neurotrophic factors are being used. A new immunosuppressant, FK 506, has replaced cyclosporin to facilitate organ transplantation, but unwanted effects, including peripheral neuropathy, have been documented in some patients. In experimental studies, FK 506 has been reported to accelerate the rate of nerve regeneration. Botulinum toxin for the treatment of localized spastic disorders is a useful therapy, but training and supervision has been recommended by the American Academy of Neurology. Experimental toxins, such as imminodipropionitrile, continue to provide useful insights into physiologic mechanisms, including the axonal transport of cytoskeletal components.