Longitudinal Patterns of Thalidomide Neuropathy in Children and Adolescents

• Published in: The Journal of pediatrics Vol. 178; pp. 227 - 232
• Main Authors: Liew, Wendy K.M., Pacak, Christina A., Visyak, Nicole, Darras, Basil T., Bousvaros, Athos, Kang, Peter B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Adolescent; Child; Crohn disease; Crohn Disease - drug therapy; Female; Humans; Immunosuppressive Agents - adverse effects; Longitudinal Studies; Male; Neural Conduction; Pediatrics; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - epidemiology; Retrospective Studies; sensorimotor polyneuropathy; thalidomide; Thalidomide - adverse effects; Young Adult; Crohn disease; sensorimotor polyneuropathy; thalidomide; SNAP; CMAP; EMG; Compound motor action potential; Electromyography; Sensory nerve action potential
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2016.07.040

To characterize the longitudinal clinical and electrophysiological patterns of thalidomide neuropathy in children and adolescents. Retrospective analysis of clinical records at a tertiary care children's hospital, including serial electrophysiological studies. Sixteen patients aged 6-24 years received thalidomide to treat Crohn's disease from 2002 to 2012. Nine subjects had electrophysiological evidence of sensorimotor axonal polyneuropathy, 8 of whom had sensory and/or motor symptoms. The patients with polyneuropathy received thalidomide for 5 weeks to 52 months, with cumulative doses ranging from 1.4 to 207.7 g. All subjects with cumulative doses greater than 60 g developed polyneuropathy, and 4 of the 5 subjects who received thalidomide for more than 20 months developed polyneuropathy. The 7 subjects who had normal neurophysiological studies received therapy for 1 week to 25 months, with cumulative doses ranging from 0.7 to 47 g. In contrast to some previous reports, several patients had sensorimotor polyneuropathies, rather than pure sensory neuropathies. In patients with neuropathy who received therapy for more than 24 months and had 3 or more electromyography studies, the severity of the neuropathy plateaued. Factors in addition to the total dose may contribute to the risk profile for thalidomide neuropathy, including pharmacogenetic susceptibilities. The severity of the neuropathy does not worsen relentlessly. Children, adolescents, and young adults receiving thalidomide should undergo regular neurophysiological studies to monitor for neuropathy.