Toxic neuropathies: a practical approach

Pract Neurol. 2023 Apr;23(2):120-130. doi: 10.1136/pn-2022-003444. Epub 2023 Jan 25.

Abstract

Toxic neuropathies result from exogenous substances damaging the peripheral nerves. There are numerous causes, including prescribed and recreational drugs, heavy metals, industrial agents and biological toxins. Timely recognition of these neuropathies gives better outcomes, as they usually improve or stabilise once the toxin is removed. Most toxic neuropathies are axonal, length-dependent and sensory predominant, although some have significant motor involvement or can present acutely or subacutely. Here, we outline our clinical approach and discuss the major causes of toxic neuropathy, while emphasising the clinical and neurophysiological features and the neuropathy phenotype. We also include an update on newer medications that can cause neuropathy, including immune checkpoint inhibitors and BRAF/MEK inhibitors.

Keywords: CLINICAL NEUROLOGY; NEUROONCOLOGY; NEUROPATHY; NEUROPHYSIOLOGY; NEUROTOXICOLOGY.

Publication types

  • Review

MeSH terms

  • Humans
  • Peripheral Nerves
  • Peripheral Nervous System Diseases* / chemically induced
  • Peripheral Nervous System Diseases* / diagnosis