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Belgian Multidisciplinary Immunotoxicity Board (BITOX)
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Neurologic
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Peripheral neurological toxicity
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Uncomplicated Peripheral neuropathy
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Uncomplicated Peripheral neuropathy – Mild
Uncomplicated Peripheral neuropathy – Mild
Mild
Moderate
Severe
Management escalation pathway
Low threshold to withhold ICPI
Close monitoring for any progression
Assessment and Investigations
Comprehensive neurological examination
Autoimmune anamnesis alcohol history, medication – diabetic screen – B12/folate – HIV – TSH – autoimmune serology – alcohol stigmata
MRI brain or spine (exclude CVA, structural cause)
Lumbar puncture to exclude tumor invasion (after brain CT scan)
Contact neurologist.
Abbreviations
Abbrevations:
CMV:
Cytomegalovirus
CIDP:
Chronic Inflammatory Demyelinating Polyneuropathy
GBS:
Guillain Barré Syndrome
PJP:
Pneumocystis Jirovei Pneumopathy
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