Childhood Thalidomide Neuropathy: A Clinical and Neurophysiologic Study

Priolo, Tiziana; Lamba, Laura Doria; Giribaldi, Gaia; De Negri, Emanuela; Grosso, Paolo; De Grandis, Elisa; Veneselli, Edvige; Buoncompagni, Antonella; Viola, Stefania; Alpigiani, Maria Giannina; Gandullia, Paolo; Calevo, Maria G.

doi:10.1016/j.pediatrneurol.2007.11.004

« Previous Next »Pediatric Neurology
Volume 38, Issue 3 , Pages 196-199, March 2008

Childhood Thalidomide Neuropathy: A Clinical and Neurophysiologic Study

Tiziana Priolo, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Laura Doria Lamba, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
- Communications should be addressed to: Dr. Lamba; Pediatric Neuropsychiatry Unit, Department of Neurosciences, Ophthalmology, and Genetics; G. Gaslini Institute, University of Genoa; L.go Gaslini 5; 16148 Genova Quarto, Italy.
Gaia Giribaldi, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Emanuela De Negri, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Paolo Grosso, PhD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Elisa De Grandis, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Edvige Veneselli, MD
- Children’s Neuropsychiatry Operative Unit, Department of Neurosciences, Ophthalmology, and Genetics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Antonella Buoncompagni, MD
- Operative Unit of Pediatrics II, Department of Pediatrics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Stefania Viola, MD
- Operative Unit of Pediatrics II, Department of Pediatrics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Maria Giannina Alpigiani, MD
- Pediatric Clinic, Department of Pediatrics, University of Genoa, IRCCS G. Gaslini Institute, Genoa, Italy
Paolo Gandullia, MD
- Operative Unit of Pediatrics III, Department of Pediatrics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
Maria G. Calevo, PhD
- Service of Epidemiology and Biostatistics, IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy.

Received 23 April 2007; accepted 12 November 2007.

Thalidomide was recently reintroduced to treat several immune-mediated pathologies. Peripheral neuropathy is a significant side effect limiting its clinical use. Our aims include: (1) describing and identifying the incidence of clinical or electrophysiologic peripheral neuropathy in children, (2) determining whether peripheral neuropathy correlates with cumulative dose of thalidomide and with age, and (3) defining its reversibility rate. We studied 13 children manifesting immune-mediated pathologies treated with thalidomide at doses ranging from 25-100 mg/day. Clinical and neurophysiologic evaluation was performed before and after starting treatment. Seven children (53.8%) showed neurophysiologic signs of sensory peripheral axonal polyneuropathy. Five presented associated clinical symptoms, while the other two only presented subclinical, neurophysiologic signs of peripheral neuropathy. We found a significant correlation between the incidence of peripheral neuropathy and thalidomide cumulative dose (P = 0.02). We observed a lower incidence of peripheral neuropathy at a cumulative dose <20 gm, and a correlation with age (P < 0.01). The clinical and electrophysiologic recovery rate was 40%, and clinical improvement alone was observed in another 40%. Thalidomide induces dose-dependent and age-dependent peripheral neuropathy at a significant frequency in childhood (53.8%). In our experience a cumulative dosage at >20 gm and long-term administration for >10 months seem to increase the risk of peripheral neuropathy. We propose clinical and neurophysiologic follow-up every 3 months to identify and monitor possible side effects.