Neuro-Oncology
Palliative and end-of-life care for neuro-oncology patients
May. 23, 2026
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Schematic of saxitoxin blockade mechanism on voltage-gated sodium channels
(A) Structural organization of the voltage-gated sodium channel complex. The voltage-gated sodium channel complex is composed of a pore-forming alpha subunit and one or more beta subunits. The alpha subunit, a single polypeptide chain with four homologous repeat domains (I to IV), constitutes the ion-conducting pore and voltage-sensing apparatus. Each domain contains six transmembrane helices (S1 to S6): S1 to S4 form the voltage sensor, and S5 to S6 form the pore domain. (B) Saxitoxin binding and functional disruption: on binding to the outer vestibule of the alpha-subunit pore via site 1, saxitoxin induces conformational contraction of the selective filter, restricting Na+ influx. This alpha-subunit-mediated disruption abrogates neuronal action potential generation (Vmax reduction 80% or greater) and propagation, leading to clinical conditions, such as facial paresthesia, limb paralysis, and respiratory arrest (From: Deng H, Shang X, Zhu H, Huang N, Wang L, Sun M. Saxitoxin: a comprehensive review of its history, structure, toxicology, biosynthesis, detection, and preventive implications. Mar Drugs 2025;23[7]:277. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)