Mechanisms of cancer-induced neurophysiological dysfunction and therapeutic strategies.
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Neurophysiological alterations represent a growing concern in oncology, affecting both the central and peripheral nervous systems through diverse mechanisms. These include direct tumor infiltration, paraneoplastic immune responses, systemic inflammation, metabolic dysregulation, and treatment-induced neurotoxicity. Neurological complications range from cognitive impairment and peripheral neuropathy to motor deficits and autonomic dysfunction. Paraneoplastic syndromes mediated by immune cross-reactivity and inflammatory cytokines such as IL-6 and TNF-α contribute to neural disruption. Cancer therapies, particularly chemotherapy, radiotherapy, and immunotherapy, increase these alterations, resulting in persistent or progressive neurological deficits. Diagnostic tools such as functional MRI, electroencephalography (EEG), cerebrospinal fluid biomarkers, and circulating tumor DNA (ctDNA) are used for earlier detection and reduced stratification risk. Management strategies incorporate neuroprotective agents (e.g., amifostine), cognitive rehabilitation, and non-invasive neuromodulation techniques. These techniques include transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Personalized neuro-oncological care is guided by biomarker-driven profiling and digital health monitoring. Pediatric patients and long-term survivors require special attention due to vulnerability to neurodevelopmental disruption. A multidisciplinary and anticipatory approach is essential for preserving neurological function and enhancing quality of life across the cancer continuum. Advances in diagnostics and therapeutics are reshaping the integration of neurophysiology within comprehensive cancer care.