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Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 2
Author(s) -
Bersano A,
Carpo M,
Cappellari A,
NobileOrazio E
Publication year - 2003
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1046/j.1529-8027.2003.00002.x
Subject(s) - medicine , lumbosacral joint , azathioprine , weakness , surgery , disease
Progressive brachial and lumbosacral radiculoplexopathies are well known, though infrequent, delayed complications of local irradiation. They present as slowly progressive, generally bilateral but asymmetric, limb weakness mainly affecting distal muscles. The pathogenesis is unknown although some authors supposed an autoimmune process or radio‐induced DNA changes. No treatment for this disease is currently available even if some benefits, though transient, have been reported after steroid treatment and more recently, high‐dose immunoglobulins (IVIg), suggesting a possible immune‐mediated pathogenesis. We previously reported on the beneficial effect of immunotherapies in two patients with postirradiation motor radiculoplexopathy. The first patient had a severe motor lumbosacral radiculoplexopathy starting 20 years after local radiotherapy for seminoma. He became able to walk and run with less waddling and to climb stairs without support after treatment with high‐dose intravenous steroids. The other patient had severe left brachial and bilateral lumbosacral plexopathies presenting 12 years after toracoascellar and lumbar irradiation for a Hodgkin lymphoma. She improved her right leg strength after one course of IVIg. After one year of continuous steroid therapy the first patient started to progressively deteriorate notwithstanding the subsequent administration of IVIg, resumed courses of steroids, plasma exchanges and azathioprine. The second patient, after one year of continuous IVIg treatment which led to stabilization without further improvement, was treated with high‐dose intravenous steroids and plasma exchange, with a marginal and transient amelioration followed by progressive worsening that was not halted by the resumption of IVIg. Both patients now suspended any therapy. In conclusion, in both our patients, immune therapies only induced a transient and short‐term benefit but did not affect the overall progression of the disease. These findings suggest that even if an immune or inflammatory component, possibly triggered by radiation, may be present in this condition, it does not probably represent the bulk of the pathological process.