51
Table 7. Nervous System Toxicities
7.4 Autonomic Neuropathy
Workup/Evaluation
An evaluation by neurologist or relevant specialist depending on organ system, with
testing which may include:
• Screen for other causes of autonomic dysfunction: diabetic screen, adrenal
insufficiency, HIV, paraproteinemia, amyloidosis, botulism, consider chronic diseases
such as Parkinson's and other autoimmune screen.
• Orthostatic vital signs.
• Consider electrodiagnostic studies (NCS and EMG) to evaluate for concurrent
polyneuropathy.
• Consider paraneoplastic autoimmune dysautonomia antibody testing (e.g., anti-
ganglionic AChR, antineuronal nuclear antibody type 1 [ANNA-1], and N-type
voltage gated calcium channel antibodies).
Grading Management
G1: Mild: no interference with
function and symptoms not
concerning to patient.
• Low threshold to hold ICPi and monitor
symptoms for a week. If to continue, monitor
very closely for any symptom progression.
G2: Moderate: some interference
with ADLs, symptoms
concerning to patient
• Hold ICPi and resume once return to ≤G1 and
off prednisone if used.
• Initial observation OR initiate prednisone 0.5–1
mg/kg/day (if progressing from mild).
• Neurolog y consultation.
G3–4: Severe: limiting self-care
and aids warranted
• Permanently discontinue ICPi.
• Admit patient.
• Initiate methylprednisolone 1 gram daily × 3
days followed by oral steroid taper.
• Neurolog y consultation.
(cont'd)
