leuprolide and Peripheral-Nervous-System-Diseases

To assess the efficacy and diagnostic value of GnRH agonist (GnRH-a) therapy in cases of hidden sciatic nerve endometriosis.. Case report.. Academic tertiary referral center for endometriosis treatment.. Three patients with cyclic, catamenial sciatica associated with pelvic endometriosis who had electromyographic evidence of sciatic nerve damage but negative computed tomography and magnetic resonance imaging findings.. Monthly administration of the GnRH-a leuprolide acetate plus daily transdermal E2 (25 microg).. Relief of pain symptoms and improvement in motor function.. All three patients had clear decreases in pain and partial amelioration of claudication.. Endometriosis of the sciatic nerve may be hard to diagnose with the use of current imaging techniques but may be proved by clinical response to GnRH analogue treatment and may be more frequent than previously thought.

Topics: Administration, Cutaneous; Adult; Drug Administration Schedule; Electromyography; Endometriosis; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Magnetic Resonance Imaging; Movement; Pain; Palliative Care; Peripheral Nervous System Diseases; Sciatic Nerve; Tomography, X-Ray Computed

The aim of this study was to investigate the indications and treatment options in patients with lower-extremity neuropathies and radiculopathies caused by endometriosis.. The authors identified five patients whose symptoms included catamenial pain, weakness, and sensory loss involving the sciatic and femoral nerves and multiple lumbosacral nerve roots. Radiographic studies supported the diagnosis of catamenial neuropathy or radiculopathy, but definitive diagnosis depended on surgical and pathological examination. Treatment of symptoms, including physical therapy and a course of antiinflammatory or analgesic medication, was not helpful. Patients responded favorably to hormonal therapy. Laparoscopy or open exploration for extrapelvic lesions was performed for diagnosis or for treatment when hormone therapy failed. Pain and sensory symptoms responded well to therapy. Weakness improved, but never recovered completely.. Catamenial neuropathy or radiculopathy should be considered when evaluating reproductive-age women with recurring focal neuropathic leg pain, weakness, and sensory loss.

Topics: Adult; Analgesics; Anti-Inflammatory Agents; Antineoplastic Agents, Hormonal; Endometriosis; Female; Femoral Nerve; Humans; Hypesthesia; Laparoscopy; Leuprolide; Low Back Pain; Lumbosacral Plexus; Menstruation; Middle Aged; Muscle Weakness; Muscular Diseases; Neuralgia; Paresthesia; Peripheral Nervous System Diseases; Physical Therapy Modalities; Radiography; Sciatic Nerve; Sciatica; Spinal Nerve Roots; Thigh; Treatment Outcome

Sciatic nerve endometriosis was previously treated primarily with surgery. Most commonly hysterectomy and bilateral salpingo-oophorectomy have been used; however, two reports also describe successful conservative surgery with resection of the endometriosis from the sciatic nerve. Only one case of sciatic nerve endometriosis has been reported to have responded to medical management. This report details the rapid and complete resolution of sciatica secondary to endometriosis after medical treatment with the gonadotropin releasing hormone analog leuprolide acetate for depot suspension.

Topics: Adult; Endometriosis; Female; Humans; Leuprolide; Peripheral Nervous System Diseases; Sciatic Nerve