Neurologische Nebenwirkungen von Zytostatika

Abstract

▼With an increasing incidence of malignancies, the number of patients treated with cytostatic chemotherapy is rising continuously. Neurological sequelae of tumor therapy are a growing concern as improved therapy protocols increase the life expectancy of patients. Despite the postmitotic state of neurons, neurotoxic phenomena are amongst the most common side eff ects of many cytostatic drugs, second only to hematological or gastroenterological toxicities. Chemotherapy-induced neurotoxic phenomena represent a medical problem as they can be dose limiting, thus preventing optimal therapy, and lead to longlasting limitations in quality of life. There are hardly any validated therapeutic or preventive approaches to neurotoxic side eff ects of cytostatic drugs. In view of the large number of possible neurotoxic symptoms, knowledge of chemotherapy-induced neurological pathologies in the central and peripheral nervous system is of practical relevance for making a diff erential diagnosis. In the context of ever more complex treatment protocols and increasing number of cytostatic drugs, we review the neurological side eff ects of chemotherapeutic drugs in general use in the peripheral and central nervous system and discuss potential therapeutic strategies. In the fi rst part, this review focuses on side eff ects in the peripheral nervous system of platinum-based antineoplastic drugs (cisplatin, carboplatin, oxaliplatin), vincaalcaloids (vincristine), taxanes (paclitaxel, docetaxel), proteasome inhibitors (bortezomib) and biologicals (brentuximab-vedotin). The second part is dedicated to neurotoxic side eff ects in the central nervous system induced by antimetabolites (methotrexate, 5-fl uoruracil, cytarabine, fl udarabine), alkylating agents (ifosfamide), platinum-based antineoplastic drugs (cisplatin), vincaalcaloids (vincristine), receptor tyrosine kinase inhibitors (imatinib, sorafenib, sunitinib) and biologicals (bevacizumab). In the third part

Antiepileptikabehandlung bei Hirntumor-bedingten epileptischen Anfällen

“…Auch eine erfolgreiche Hirnödembehandlung mit Glukokortikoiden führt zu einer Abnahme des Anfallsrisikos [91]. Im Einzelfall sol- ▶ selten (0 -5 %) bei 5-Fluorouracil, Cisplatin, Vincristin ▶ gelegentlich (5 -15 %) bei Methotrexat und Cytarabin [168] Weitere Angaben zur Möglichkeit einer Anfallssteigerung durch Zytostatika liegen vor bei Ifosfamid [164], L-Asparaginase, Etoposid, Interleukin-2, Busulfan, BCNU, Carboplatin, Cytosin-Arabinosid [99,169], Bevacizumab, Interferon-Alpha, Zyklophosphamid, Anthrazyklinen, Nitrosoharnstoffen [27]. Im Fall einer Anfallszunahme unter der Behandlung muss differentialdiagnostisch eine Tumorprogredienz bzw.…”