Pregabalin Attenuates Carboplatin-Induced Akathisia-Like Neuropathy: A Novel Case Report

Our plain-English summary of Pregabalin Attenuates Carboplatin-Induced Akathisia-Like Neuropathy: A Novel Case Report, by Y. Saito, Y. Takekuma, M. Furuta, et al (Case Reports in Oncology, 2021).

The study

• Authors: Y. Saito, Y. Takekuma, M. Furuta, M. Sugawara
• Journal: Case Reports in Oncology
• Published: 2021;14(3):1418-1421
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most serious adverse effects of chemotherapy. We experienced carboplatin (CBDCA)-induced akathisia-like CIPN, which was significantly attenuated by pregabalin administration, and report its treatment. A man in his 40s was administered CBDCA + pemetrexed (PEM) as the third-line treatment for recurrent malignant pleural mesothelioma. He rarely experienced mild akathisia-like symptoms on his feet before the diagnosis. The patient claimed that he exhibited mild degradation of the symptoms in the previous cisplatin (CDDP) + PEM treatment without the need for pharmacotherapy. Symptoms notably worsened approximately 7 days after the first cycle of CBDCA + PEM and did not disappear. Furthermore, symptoms worsened during the daytime and became milder at night. Lorazepam (0.5 mg) was administered 3 times a day from day 14 but was not effective. Finally, we evaluated the symptoms to be derived from CBDCA-induced neuropathy as he experienced the same symptoms in CDDP + PEM and did not have suspicious pathology or medicines for akathisia development. We decided to administer 75 mg pregabalin twice daily, resulting in significant symptom improvement. He also complained that he felt the symptoms 10 h after the previous pregabalin dose, suggesting that pregabalin was effective, and its effect weakened or disappeared as time progressed. Akathisia-like symptoms caused by CBDCA-induced CIPN are rare, but they significantly reduce the quality of life. Pregabalin was significantly effective in this case; therefore, we suggest that a detailed symptom interview and selection of the medicine, based upon the action mechanism, are necessary.

Copyright © 2021 by S. Karger AG, Basel.

In plain English

This case report described one man in his 40s with recurrent malignant pleural mesothelioma. He had earlier been treated with cisplatin plus pemetrexed and then nivolumab, and he then received carboplatin plus pemetrexed as third-line treatment. Before his diagnosis he had rarely had mild restless, akathisia-like feelings in his feet. About 7 days after the first carboplatin cycle these symptoms worsened to grade 2 and did not go away. They were severe during the day and milder at night. Lorazepam 0.5 mg three times a day, started on day 14, did not help. The authors judged the symptoms to be nerve damage caused by carboplatin, although he lacked typical signs such as numbness, tingling and pain. They noted that these conditions are difficult to tell apart during chemotherapy. Pregabalin 75 mg twice daily, started with the second course, relieved the symptoms. He said they disappeared even in the daytime, and he had grade 1 drowsiness. The symptoms returned about 10 hours after a dose. The authors concluded that pregabalin was effective in this case.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One man in his 40s with recurrent malignant pleural mesothelioma. He had previously received 3 courses of cisplatin plus pemetrexed and 32 courses of nivolumab. The authors are from Hokkaido University Hospital and Hokkaido University, Sapporo, Japan.
• Exposure: Chemotherapy with carboplatin (dosed to an area under the curve of 5) plus pemetrexed (500 mg/m2), given as third-line treatment. No asbestos exposure is described.
• Main results:
  • In this patient, the akathisia-like symptoms worsened to grade 2 about 7 days after the first cycle of carboplatin plus pemetrexed and did not disappear.
  • Lorazepam 0.5 mg three times a day, given from day 14, was not effective.
  • The symptoms were severe during the day and milder (almost disappeared) at night.
  • Pregabalin 75 mg twice daily was given from the start of the second course. The patient described the symptoms as having disappeared, even in the daytime, and he had grade 1 drowsiness.
  • The patient felt the symptoms again about 10 hours after the previous pregabalin dose.
  • Chemotherapy was stopped after the second course and surgery was performed. The symptoms gradually improved after chemotherapy ended.
• The authors' conclusion: The authors concluded that akathisia-like symptoms caused by carboplatin-induced peripheral neuropathy are rare but reduce quality of life. They concluded that pregabalin was effective in this case, and they suggested a detailed symptom interview and choosing a medicine based on its mechanism of action.
• Limitations the authors state:
  • The patient did not show the typical signs of chemotherapy-induced peripheral neuropathy, such as numbness, tingling and pain.
  • The authors stated that akathisia, restless legs syndrome and chemotherapy-induced peripheral neuropathy are difficult to distinguish accurately during chemotherapy.
  • The authors noted that carboplatin uncommonly causes peripheral neuropathy at standard doses.
  • The patient had akathisia-like symptoms before chemotherapy. The authors said this background may have affected how the symptoms developed.

Topics

Medical terms in this study, explained in our Lexicon: Carboplatin, Chemotherapy, Pemetrexed (Alimta), Pleural Mesothelioma, Cisplatin, Pathology, Quality of Life.

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