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NCI CTCAE v5.0 neurotoxicity

NCI CTCAE v5.0 neurotoxicity
Adverse event Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Depressed level of consciousness Decreased level of alertness Sedation; slow response to stimuli; limiting instrumental ADL* Difficult to arouse Life-threatening consequences; coma; urgent intervention indicated Death
Dysphasia Awareness of receptive or expressive characteristics; not impairing ability to communicate Moderate receptive or expressive characteristics; impairing ability to communicate spontaneously Severe receptive or expressive characteristics; impairing ability to read, write, or communicate intelligibly    -
Edema cerebral     New onset; worsening from baseline Life-threatening consequences; urgent intervention indicated Death
Encephalopathy Mild symptoms Moderate symptoms; limiting instrumental ADL* Severe symptoms; limiting self-care ADL* Life-threatening consequences; urgent intervention indicated Death
Headache Mild pain Moderate pain; limiting instrumental ADL* Severe pain; limiting self-care ADL*    -
Paresthesia Mild symptoms Moderate symptoms; limiting instrumental ADL* Severe symptoms; limiting self-care ADL*    -
Peripheral motor neuropathy Asymptomatic; clinical or diagnostic observations only Moderate symptoms; limiting instrumental ADL* Severe symptoms; limiting self-care ADL* Life-threatening consequences; urgent intervention indicated Death
Peripheral sensory neuropathy Asymptomatic Moderate symptoms; limiting instrumental ADL* Severe symptoms; limiting self-care ADL* Life-threatening consequences; urgent intervention indicated  -
Seizure Brief partial seizure and no loss of consciousness Brief generalized seizure New onset seizures (partial or generalized); multiple seizures despite medical intervention Life-threatening consequences; prolonged repetitive seizures Death
Tremor Mild symptoms Moderate symptoms; limiting instrumental ADL* Severe symptoms; limiting self-care ADL*    -
Definitions are based on the CTCAE document:
  • Depressed level of consciousness is characterized by a decrease in ability to perceive and respond.
  • Dysphasia is characterized by impairment of verbal communication skills, often resulting from brain damage.
  • Edema cerebral is characterized by swelling due to an excessive accumulation of fluid in the brain.
  • Encephalopathy is characterized by a pathologic process involving the brain.
  • Headache is characterized by a sensation of marked discomfort in various parts of the head, not confined to the area of distribution of any nerve.
  • Paresthesia is characterized by functional disturbances of sensory neurons resulting in abnormal cutaneous sensations of tingling, numbness, pressure, cold, and warmth that are experienced in the absence of a stimulus.
  • Peripheral motor neuropathy is characterized by inflammation or degeneration of the peripheral motor nerves.
  • Peripheral sensory neuropathy is characterized by inflammation or degeneration of the peripheral sensory nerves.
  • Seizure is characterized by a sudden, involuntary skeletal muscular contractions of cerebral or brain stem origin.
  • Tremor is characterized by the uncontrolled shaking movement of the whole body or individual parts.
NCI CTCAE: National Cancer Institute Common Terminology Criteria for Adverse Events; ADL: activities of daily living.
* Instrumental ADLs include preparing meals, shopping, using the telephone, managing money. Self-care ADLs include bathing, dressing/undressing, using the toilet, taking medications, and not bedridden.
Reproduced from: Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017, National Institutes of Health, National Cancer Institute. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf (Accessed March 27, 2018).
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