AUTHOR=Cho Kye Hee , Han Eun Young , Shin Ji Cheol , Ha Min Cheol , Ahn Kwang Ho , Cho Su Hyun , IM Sang Hee 

TITLE=Comparison of Clinical Symptoms and Neurophysiological Findings in Patients With Chemotherapy Induced Peripheral Neuropathy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.838302

DOI=10.3389/fneur.2022.838302

ISSN=1664-2295

ABSTRACT=Introduction
Taxane-based chemotherapeutics are associated with a distal sensory neuropathy, significantly affecting cancer survivor quality of life. However, chemotherapy-induced peripheral neuropathy (CIPN) assessments are primarily based on clinical symptoms rather than objective neurophysiologic findings. Therefore, we investigated neurophysiologic changes in symptomatic subjects, comparing them with symptom severity.
Materials and methods
Medical charts of subjects with breast or ovarian cancer between May 1, 2016, and December 31, 2019, were retrospectively reviewed. Demographics, anthropometric parameters, and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale data were collected. NCS results, including sensory nerve action potentials recorded from sural nerves, were analyzed relative to clinical symptoms. To optimize follow-up (FU) NCS diagnostic sensitivity, relative references of FU sural amplitude reductions to >30% and an absolute reference <10 µV were used. 
Results
Eighty-eight female patients met the criteria, and 20 underwent FU NCS. Baseline and FU sural amplitudes were significantly positively correlated with respective LANSS scores (p<0.01). FU sural amplitude was significantly lower than the initial result (p<0.05). The FU LANSS score was not different from the initial score. Initial NCS sensitivity and specificity for clinically suspected CIPN diagnoses with LANSS were 56.5% and 69.0%, respectively. All 20 subjects with FU evaluation were clinically compatible with CIPN (LANSS >12) at initial and FU assessments. Among them, only nine (45.0%) had abnormal sural amplitudes (<10 µV) in the initial NCS. In the FU NCS, sural amplitude became abnormal in five additional subjects. Between the initial and FU NCS, sural amplitude was reduced by >30% in eight subjects (40.0%). NCS sensitivity increased to 80% when including either <10 µV of sural amplitude or a >30% reduction in sural amplitude in FU studies.
Conclusions
Although clinical symptoms and NCS results were positively correlated, a single NCS point had limited value for suspected CIPN electrophysiological diagnoses. Serial NCS during chemotherapy might help assess the degree of chemotherapy-induced nerve damage, attain evidence of CIPN prior to symptom aggravation, and monitor the progression of CIPN. Further study is needed to find specific relative references for variable patient factors to increase the sensitivity of electrophysiological studies of clinically suspected CIPN.