PD – Detrusor Overactivity Treatment (Mirabegron) — SCE Neurology MCQ

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HardMovement DisordersPD – Detrusor Overactivity Treatment (Mirabegron)SCE Neurology

A patient with systemic POEMS syndrome has severe demyelinating neuropathy and requires plasma-cell-directed systemic therapy. Which agent is comparatively least likely to compound the neuropathy and is used as a first-line systemic option?

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Correct answer: A — Lenalidomide

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

A frequently causes a cumulative sensory neuropathy and is unattractive in severe baseline neuropathy. B is correct: lenalidomide is substantially less neurotoxic than thalidomide and is used in first-line systemic POEMS regimens, selected with haematology and according to disease extent and transplant suitability. C is strongly neurotoxic. D can worsen neuropathy, particularly with intravenous rather than subcutaneous delivery. E commonly causes a length-dependent sensory neuropathy. The key is to treat the plasma-cell disorder without predictably worsening neurological disability.

Reference: Toxic neuropathies: a practical approach: https://pn.bmj.com/content/23/2/120