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P H Hilkens

Publications and source records attributed to P H Hilkens.

15 recordsLinked to original sources
PubMed2001

Intramedullary enterogenous cyst presenting with spastic paraparesis during two consecutive pregnancies: a case report.

A 35 year old woman presented with two episodes of spastic paraparesis, occurring in the third trimester of two consecutive pregnancies. The neurological symptoms seemed to be caused by an intramedullary cyst in the thoracic spinal cord. The cyst was subtotally removed and histopathologically diagnosed as enterogenous cyst. Other congenital abnormalities were absent. The peculiar timing of the clinical manifestation of an intramedullary cyst has not been described before. An unequivocal explanation for this phenomenon is missing, but several factors related to pregnancy that may play a part are discussed.

Central Nervous System Cysts↗
PubMed1998

Corticosteroid co-medication does not reduce the incidence and severity of neurotoxicity induced by docetaxel.

Docetaxel is a new antimicrotubule agent that induces a predominantly sensory neuropathy that is mild in most patients. This prospective study was performed to determine if corticosteroid co-medication reduces the incidence and severity of docetaxel-induced neuropathy. Two groups of patients treated with docetaxel in subsequent cohorts were prospectively analyzed for neurotoxicity. Group A consisted of 38 patients with a variety of solid tumors, who were treated in studies before corticosteroid co-medication was recommended, while 49 female patients in group B with metastatic breast cancer were treated after co-medication with corticosteroids was introduced as a routine. Neuropathy was evaluated by a clinical sum-score for symptoms and signs, and by measurement of the vibration perception threshold (VPT). The severity of neuropathy was graded according to NCI Common Toxicity Criteria. In 42% of patients of group A and in 65% of patients of group B a mainly mild neuropathy was documented. There was no statistically significant difference in neurotoxicity between group A and B. The cumulative dose of docetaxel showed a significant correlation with post-treatment scores of VPT, sensory sum-score, grade of paresthesias, and grade of neurosensory and neuromotor toxicity. Corticosteroid co-medication does not reduce the development of docetaxel-related neuropathy.

Adult↗
PubMed1998

Lhermitte's sign following chemotherapy with docetaxel.

Specific causes for Lhermitte's sign (LS) in cancer patients are spinal cord compression, radiation therapy to the spinal cord, and cisplatin chemotherapy. We observed a transient LS in five of 87 patients treated with more than two cycles of 100 mg/m2 docetaxel (Taxotere). LS developed either concurrently or after the onset of docetaxel-induced sensory neuropathy, and disappeared after the discontinuation or dose reduction of chemotherapy.

Adult↗
PubMed1997

Clinical characteristics of severe peripheral neuropathy induced by docetaxel (Taxotere).

BACKGROUND: Docetaxel, a semi-synthetic taxane may cause a usually mild sensory neuropathy. We describe the clinical characteristics of five patients who developed a more severe neuropathy following treatment with docetaxel. PATIENTS AND METHODS: All patients were treated in phase II studies with 100 mg/m2 docetaxel in three weekly cycles, without steroid administration. RESULTS: The clinical picture in these patients was dominated by a sensory neuropathy, but in one case severe weakness was present. Another patient developed Lhermitte's sign. Signs and symptoms are usually reversible after discontinuation of docetaxel administration, but in three patients symptoms worsened for some time after the end of treatment before improvement occurred. CONCLUSION: Severe docetaxel neuropathy may especially occur following treatment with cumulative dosage over 600 mg/m2; in patients treated with this dosage a moderate or severe neuropathy may not be rare.

Adult↗
PubMed1997

Peripheral neuropathy induced by combination chemotherapy of docetaxel and cisplatin.

Docetaxel, a new semisynthetic taxoid that has demonstrated promising activity as an antineoplastic agent, was administered in combination with cisplatin to 63 patients in a dose-escalating study. As both drugs were known to be potentially neurotoxic, peripheral neurotoxicity was prospectively assessed in detail. Neuropathy was evaluated by clinical sum-score for signs and symptoms and by measurement of the vibration perception threshold (VPT). The severity of neuropathy was graded according to the National Cancer Institute's 'Common Toxicity Criteria'. The docetaxel-cisplatin combination chemotherapy induced a predominantly sensory neuropathy in 29 (53%) out of 55 evaluable patients. At cumulative doses of both cisplatin and docetaxel above 200 mg m(-2), 26 (74%) out of 35 patients developed a neuropathy which was mild in 15, moderate in ten and severe in one patient. Significant correlations were present between both the cumulative dose of docetaxel and cisplatin and the post-treatment sum-score of neuropathy (P < 0.01) as well as the post-treatment VPT (P < 0.01). The neurotoxic effects of this combination were more severe than either cisplatin or docetaxel as single agent at similar doses.

Adolescent↗
PubMed1997

Phase I and pharmacologic study of docetaxel and cisplatin in patients with advanced solid tumors.

PURPOSE: This phase I study was performed to assess the feasibility of the combination of docetaxel and cisplatin and to determine the maximum-tolerated dose (MTD) and the side effects with an emphasis on sequence-dependent side effects. MATERIALS AND METHODS: Patients who were not pretreated with taxanes or cisplatin derivatives and who had received no more than one prior combination chemotherapy regimen or two single-agent regimens were entered. Treatment consisted of docetaxel given as a 1-hour infusion followed by cisplatin as a 3-hour infusion (schedule A), or cisplatin followed by docetaxel (schedule B). Docetaxel doses ranged from 55 to 100 mg/m2 and cisplatin doses from 50 to 100 mg/m2. RESULTS: Leukocytopenia and granulocytopenia were common (overall, 90%; grade 3 or 4, 87%), short-lasting, and docetaxel dose-dependent. Infections and neutropenic fever occurred in 10% and 4.5% of courses, respectively. Nonhematologic toxicities were mild to moderate and included alopecia, nausea, vomiting, diarrhea, mucositis, neurotoxicity, fluid retention, and skin and nail toxicity. There were no significant differences in pharmacokinetic parameters between schedules A and B. Tumor responses included one complete response (CR) and nine partial responses (PRs). CONCLUSION: The dose levels docetaxel 100 mg/m2 plus cisplatin 75 mg/m2 and docetaxel 85 mg/m2 plus cisplatin 100 mg/m2 appeared to be manageable. At these dose levels, the median relative dose-intensity was high and 81% and 88% of all cycles, respectively, could be given at full dose. Schedule A is advocated for further treatment.

Adult↗
PubMed1997

Chemotherapy-induced peripheral neuropathy.

Peripheral neurotoxicity is an important side-effect of several chemotherapeutic agents. These agents may cause a usually axonal neuropathy, which may ultimately lead to severe and disabling symptoms and signs. We describe in this review the pathogenesis, clinical presentation, neurophysiologic findings, nerve biopsies and the relation between cumulative dosage/dosage per cycle and neuropathy for the cytostatic drugs for which neurotoxicity is an important side-effect: cisplatin, vincristine, paclitaxel, docetaxel and suramin. With the development of strategies to circumvent toxicities of other organs and with the use of combinations of neurotoxic agents such as cisplatin/paclitaxel, neurotoxicity is an important and dose-limiting side-effect of many treatment regimens. Detailed knowledge of the neurologic side-effects of these drugs is essential for the management of their neurotoxicity. The review concludes with a short discussion of neuroprotective agents. Although several nerve growth factors, gluthatione and ethiofos hold promise as possible neuroprotective factors, the clinical data on these drugs are still limited. New trials are needed to confirm the value of these drugs. If neurotoxicity could indeed be prevented or delayed, this may lead to more effective treatment regimens.

Animals↗
PubMed1996

Peripheral neurotoxicity induced by docetaxel.

Docetaxel, a new semisynthetic taxoid used as an antineoplastic agent, induced a predominantly sensory neuropathy in 20 of 41 patients. We assessed neurotoxicity in all patients participating in four phase II trials conducted in our institution. The neuropathy was evaluated by a clinical sum-score for symptoms and signs and by measurement of the Vibration Perception Threshold (VPT). The severity of neuropathy was graded according to the National Cancer Institute's Common Toxicity Criteria. Neuropathic symptoms were mild in most patients. However, at cumulative doses above 600 mg/m2, 3 of 15 patients developed a moderate and 1 of 15 patients a severe neuropathy. There was a significant correlation between the cumulative dose of docetaxel and the post-treatment sum-score (p = 0.002). We found no correlation between post-treatment VPT and clinical sum-score or between post-treatment VPT and the cumulative dose of docetaxel. We conclude that docetaxel produced a mild and predominantly sensory neuropathy in a high proportion of treated patients. This neurotoxicity appeared to be dose dependent and may be severe and disabling at higher dose levels. Determination of the VPT is not a reliable method to monitor docetaxel-induced neuropathy.

Adult↗
PubMed1995

Effect of an ACTH(4-9) analogue on cisplatin neuropathy of longstanding duration: a phase II study.

The efficacy of Org 2766, an ACTH(4-9) analogue, on the recovery of cisplatin neuropathy of longstanding duration was investigated in a phase II study. Twenty-two patients were treated with Org 2766 during a period of 4 months and vibration perception threshold (VPT) and sum scores for neuropathic symptoms and signs were compared with pre-treatment values. No change in VPT could be detected. Although there was a small improvement of clinical measures for neuropathy, no clear evidence for repair could be obtained. These results indicate no beneficial effect of Org 2766 on recovery of a longstanding cisplatin neuropathy.

Adrenocorticotropic Hormone↗
PubMed1995

Neurotoxicity is not enhanced by increased dose intensities of cisplatin administration.

It is uncertain whether intensive dosing schedules of cisplatin, intended to attain a higher anti-tumour efficacy, alter the severity of cisplatin-induced neuropathy. We assessed the development of neuropathy in three groups of patients treated with cisplatin in different dosing schedules. The severity of neuropathy was determined by measurement of the vibration perception threshold (VPT) before treatment and during follow-up for 2-12 months after the last cycle. 66 patients were treated with an intensive weekly regimen of doses varying from 70 to 85 mg/m2 in 1 day (trial A), 21 patients with a 3-weekly combination chemotherapy containing cisplatin 75 mg/m2 in 1 day (trial B) and 20 patients with a 3-weekly regimen containing cisplatin 20 mg/m2 for 5 consecutive days (trial C). The mean dose intensity achieved was 59 mg/m2/week in trial A, 21 mg/m2/week in trial B and 33 mg/m2/week in trial C. The maximum post-treatment VPT correlated significantly with pretreatment VPT (P < 0.001) and with the cumulative dose of cisplatin (P < 0.001). Following correction for these two variables, the maximum posttreatment VPT did not show a statistically significant association with dose intensity. These results suggest that neuropathy is not related to dose intensity of cisplatin. This implies that treatment with more intensive dosing schedules, employing equal cumulative doses of cisplatin, does not result in a concomitant increase in neurotoxicity within a cumulative dose range of 280-675 mg/m2.

Adolescent↗
PubMed1995

Non-convulsive status epilepticus as cause for focal neurological deficit.

In a four-and-a-half year period, 19 patients with focal neurological deficits accompanied by a focal electrographic status epilepticus were encountered. Sixteen of these patients showed clouding of consciousness or confusion. Computed tomography of the brain revealed focal lesions in 15 patients. In 7 patients the lesions were the result of a recent cerebral event and in 8 patients they were long-standing. All patients were treated with anti-epileptic drugs. Ten of the 12 patients without an acute lesion showed a complete recovery in a few days. In these patients the symptoms may have been caused by the continuous seizure activity, classifying them as cases of non-convulsive focal status epilepticus. Only 2 of the 7 patients with an acute lesion had a full recovery. In patients with an acute lesion the part played by the electrographic status epilepticus in the acquired deficits is unclear. Continuous or frequent intermittent focal epileptic discharges on the EEG may warrant treatment with anti-epileptic drugs in patients with focal neurological deficits, even when one of the hallmarks of epilepsy, clonic movements, is absent.

Adult↗
PubMed1995

Normal pressure hydrocephalus associated with rheumatoid arthritis responding to prednisone.

We describe 2 patients with longstanding rheumatoid arthritis (RA) complicated by normal pressure hydrocephalus. After treatment with prednisone, both patients improved remarkably with respect to mental status, urinary control, and gait. We suggest that normal pressure hydrocephalus may occur as an extraarticular manifestation of RA, and studies are warranted to confirm a beneficial response to prednisone.

Aged↗