Characteristics of radiogenic lower motor neurone disease, a possible link with a preceding viral infection

Research output: Contribution to journalArticle

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Abstract

Objective: To investigate the pathogenesis of the rare radiogenic lower motor neurone disease (LMND) on the basis of a meta-analysis of the published case histories. Materials and methods: The authors reviewed 47 well-documented radiogenic LMND cases from the English literature. Results: The disease typically occurs following the irradiation of radiosensitive cancers situated near the spinal cord. It arises predominantly (46 cases) in the lower extremities; only one case involved the upper extremities. There is a male predominance (male:female ratio 7.8:1), and the patients are characteristically young (13-40 years, with four exceptions). An overdose does not seem to be a particular risk factor for the development of the disease, as total dose, fraction size and biologically effective dose are typically below 50 Gy, 2 Gy and 128 Gy2, respectively, which are regarded as safe doses. Other risk factors (chemotherapy, operations, etc) have been identifed only rarely. Radiogenic LMND is manifested in an apparently random manner, 4-312 (mean 48.7) months after the completion of radiotherapy. Discussion: The complete lack of a dose-effect relationship argues strongly against a pure radiogenic nature of the pathological process. The latency period is typically several years and it varies extremely, which excludes a direct and complete causal relationship between radiotherapy and LMND. As the interaction of ionizing radiation with living tissues is highly unspecific, thus a selective motor injury due to irradiation alone, without comparable effects on the sensory and vegetative fibers, seems improbable. Conclusions: On analogy with the viral motor neurone diseases, we suppose that radiogenic LMND may be preceded by viral (enterovirus/poliovirus) infection. Based on the meta-analysis, it is suggested that irradiation may be only a single component of the set of factors jointly resulting in the clinical state regarded as radiogenic LMND.

Original languageEnglish
Pages (from-to)99-105
Number of pages7
JournalSpinal Cord
Volume42
Issue number2
DOIs
Publication statusPublished - Feb 2004

Fingerprint

Motor Neuron Disease
Virus Diseases
Meta-Analysis
Radiotherapy
Enterovirus Infections
Literature
Poliovirus
Pathologic Processes
Ionizing Radiation
Upper Extremity
Lower Extremity
Spinal Cord
Drug Therapy
Wounds and Injuries

Keywords

  • Chemotherapy
  • Irradiation
  • Lower motor neurone disease
  • Viral infection

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Characteristics of radiogenic lower motor neurone disease, a possible link with a preceding viral infection. / Ésik, O.; Vönöczky, K.; Lengyel, Z.; Sáfrány, G.; Trón, L.

In: Spinal Cord, Vol. 42, No. 2, 02.2004, p. 99-105.

Research output: Contribution to journalArticle

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abstract = "Objective: To investigate the pathogenesis of the rare radiogenic lower motor neurone disease (LMND) on the basis of a meta-analysis of the published case histories. Materials and methods: The authors reviewed 47 well-documented radiogenic LMND cases from the English literature. Results: The disease typically occurs following the irradiation of radiosensitive cancers situated near the spinal cord. It arises predominantly (46 cases) in the lower extremities; only one case involved the upper extremities. There is a male predominance (male:female ratio 7.8:1), and the patients are characteristically young (13-40 years, with four exceptions). An overdose does not seem to be a particular risk factor for the development of the disease, as total dose, fraction size and biologically effective dose are typically below 50 Gy, 2 Gy and 128 Gy2, respectively, which are regarded as safe doses. Other risk factors (chemotherapy, operations, etc) have been identifed only rarely. Radiogenic LMND is manifested in an apparently random manner, 4-312 (mean 48.7) months after the completion of radiotherapy. Discussion: The complete lack of a dose-effect relationship argues strongly against a pure radiogenic nature of the pathological process. The latency period is typically several years and it varies extremely, which excludes a direct and complete causal relationship between radiotherapy and LMND. As the interaction of ionizing radiation with living tissues is highly unspecific, thus a selective motor injury due to irradiation alone, without comparable effects on the sensory and vegetative fibers, seems improbable. Conclusions: On analogy with the viral motor neurone diseases, we suppose that radiogenic LMND may be preceded by viral (enterovirus/poliovirus) infection. Based on the meta-analysis, it is suggested that irradiation may be only a single component of the set of factors jointly resulting in the clinical state regarded as radiogenic LMND.",
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