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Lane O, Ambai V, Bakshi A, Potru S. Alcohol use disorder in the perioperative period: a summary and recommendations for anesthesiologists and pain physicians. Reg Anesth Pain Med 2024; 49:621-627. [PMID: 38050177 DOI: 10.1136/rapm-2023-104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/26/2023] [Indexed: 12/06/2023]
Abstract
Excessive alcohol consumption and alcohol use disorder (AUD) increase the risk of perioperative morbidity and mortality. Aspiration, malnutrition, coagulopathies, seizures, and hemodynamic alterations are only a few of the major concerns related to acute alcohol intoxication and AUD. There are also numerous physiological effects, changes in medication metabolism and pharmacology, and adverse events related to chronic alcohol consumption. These are all important considerations for the anesthesiologist in the perioperative management of a patient with AUD. Pain perception and thresholds are altered in patients with acute and chronic alcohol use. Medications used to manage AUD symptoms, particularly naltrexone, can have significant perioperative implications. Patients on naltrexone who continue or stop this medication in the perioperative period are at an increased risk for undertreated pain or substance use relapse. This review highlights key considerations for the anesthesiologist and pain physician in the perioperative management of patients with active AUD (or those in recovery). It discusses the effects of acute and chronic alcohol use on pain perception and thresholds, provides guidance on the perioperative management of naltrexone and low-dose naltrexone, and reviews a multimodal approach to pain management.
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Affiliation(s)
- Olabisi Lane
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vats Ambai
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arjun Bakshi
- Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sudheer Potru
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Dalrymple AN, Fisher LE, Weber DJ. A preliminary study exploring the effects of transcutaneous spinal cord stimulation on spinal excitability and phantom limb pain in people with a transtibial amputation. J Neural Eng 2024; 21:046058. [PMID: 39094627 PMCID: PMC11391861 DOI: 10.1088/1741-2552/ad6a8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 08/02/2024] [Indexed: 08/04/2024]
Abstract
Objective. Phantom limb pain (PLP) is debilitating and affects over 70% of people with lower-limb amputation. Other neuropathic pain conditions correspond with increased spinal excitability, which can be measured using reflexes andF-waves. Spinal cord neuromodulation can be used to reduce neuropathic pain in a variety of conditions and may affect spinal excitability, but has not been extensively used for treating PLP. Here, we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP and modulate spinal excitability after transtibial amputation.Approach. We recruited three participants, two males (5- and 9-years post-amputation, traumatic and alcohol-induced neuropathy) and one female (3 months post-amputation, diabetic neuropathy) for this 5 d study. We measured pain using the McGill Pain Questionnaire (MPQ), visual analog scale (VAS), and pain pressure threshold (PPT) test. We measured spinal reflex and motoneuron excitability using posterior root-muscle (PRM) reflexes andF-waves, respectively. We delivered tSCS for 30 min d-1for 5 d.Main Results. After 5 d of tSCS, MPQ scores decreased by clinically-meaningful amounts for all participants from 34.0 ± 7.0-18.3 ± 6.8; however, there were no clinically-significant decreases in VAS scores. Two participants had increased PPTs across the residual limb (Day 1: 5.4 ± 1.6 lbf; Day 5: 11.4 ± 1.0 lbf).F-waves had normal latencies but small amplitudes. PRM reflexes had high thresholds (59.5 ± 6.1μC) and low amplitudes, suggesting that in PLP, the spinal cord is hypoexcitable. After 5 d of tSCS, reflex thresholds decreased significantly (38.6 ± 12.2μC;p< 0.001).Significance. These preliminary results in this non-placebo-controlled study suggest that, overall, limb amputation and PLP may be associated with reduced spinal excitability and tSCS can increase spinal excitability and reduce PLP.
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Affiliation(s)
- Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, United States of America
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States of America
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, United States of America
- NERVES Lab, University of Utah, Salt Lake City, UT, United States of America
| | - Lee E Fisher
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Neural Basis of Cognition, Pittsburgh, PA, United States of America
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, United States of America
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, United States of America
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3
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Patel H, Abedi M, Abedi A, Patel T. Brachial Plexus Palsy: A Case Report of Compression-Induced Injury Associated With Alcohol Intoxication. Cureus 2024; 16:e64226. [PMID: 39130905 PMCID: PMC11315434 DOI: 10.7759/cureus.64226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Brachial plexus palsy is a complex neuropathy associated with traumatic injuries, inflammatory processes, and tumors. In this report, we present an unusual case of brachial plexus palsy in a 72-year-old man with a history of chronic alcohol abuse. The patient presented to the emergency room with left arm weakness following a fall under the influence of alcohol that resulted in prolonged immobilization. An initial neurologic exam identified paralysis, numbness, and pain in the left upper extremity; however, further studies confirmed the absence of acute fractures or evidence of compartment syndrome. This case highlights the potential for alcohol intoxication and prolonged immobilization, in the absence of traumatic injury, as a contributing cause of brachial plexus palsy. Furthermore, this case emphasizes the importance of considering alternative causes of brachial plexus injury for prompt diagnosis and treatment.
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Affiliation(s)
- Hejal Patel
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Maleeha Abedi
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Afrah Abedi
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Twinkle Patel
- Geriatric Medicine, Loretto Health and Rehabilitation, Syracuse, USA
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Papantoniou M, Rentzos M, Zampelis T, Tzavellas E, Paparrigopoulos T, Kokotis P. Alcohol-related peripheral neuropathy: Clinico-neurophysiological characteristics and diagnostic utility of the neuropathy symptoms score and the neuropathy impairment score. Alcohol 2024; 117:65-71. [PMID: 38580031 DOI: 10.1016/j.alcohol.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Alcohol overconsumption is well known to cause damage to the peripheral nervous system, affecting both small and large nerve fibers. The aim of this descriptive study was to investigate peripheral nerve damage, and to correlate clinical, epidemiological and neurophysiological findings, in patients diagnosed with Alcohol Use Disorder (AUD). Ninety alcohol-dependent subjects on inpatient basis were enrolled in this prospective study over a 3-year period. Every subject was assessed by the Neuropathy Symptoms Score (NSS) questionnaire and the Neuropathy Impairment Score (NIS) clinical examination grading scale, followed by Nerve Conduction Studies, Quantitative Sensory Testing and Sympathetic Skin Response (SSR) testing. Peripheral neuropathy was diagnosed in 54 subjects (60%), by abnormal neurophysiological tests and presence of clinical signs or symptoms. Among them, pure large fiber neuropathy (LFN) was found in 18 subjects, pure small fiber neuropathy (SFN) in 12 subjects, and both large and small fiber neuropathy was diagnosed in 24 subjects. Using linear regression, we found that higher NSS and NIS scores correlated with lower amplitudes of the sural sensory nerve action potential and of the SSR. We also found a significant longer duration of alcohol abuse in subjects with neuropathy, using Student's t-test (p = 0.024). Additionally, applying NIS abnormal cut-off score ≥4, using ROC analysis, we predicted the majority of subjects with LFN, confirming 95.23% sensitivity and 93.75% specificity. Our study confirmed that peripheral neuropathy involving large and small nerve fibers, with a symmetrical length-dependent pattern, is common between patients with AUD and related to the duration of the disorder. We suggest that NSS and NIS scales could be used for the assessment of neuropathy in clinical practice, when the essential neurophysiological testing is not available.
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Affiliation(s)
- Michail Papantoniou
- Laboratory of Clinical Neurophysiology, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Michail Rentzos
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Zampelis
- Laboratory of Clinical Neurophysiology, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Tzavellas
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Paparrigopoulos
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- Laboratory of Clinical Neurophysiology, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Gnonlonfoun DD, Sowanou A, Gnigone P, Gbessemehlan A, Choki B, Agbetou M, Houeze R, Agassounon R, Metogbe Hountovo A, Adoukonou T, Magne J, Boumediene F, Preux PM, Houinato D. Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021. Int J Neurosci 2024:1-9. [PMID: 38465511 DOI: 10.1080/00207454.2024.2328709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP. MATERIALS AND METHODS It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP. RESULTS 645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level. CONCLUSION This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.
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Affiliation(s)
- Dieu Donné Gnonlonfoun
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Arlos Sowanou
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Pupchen Gnigone
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Antoine Gbessemehlan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Blaise Choki
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | - Richard Houeze
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Rhodya Agassounon
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | | | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
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Moskal D, Loughran TA, Funderburk JS, Scharer JL, Buckheit KA, Beehler GP. Pain and Hazardous Alcohol Use in Veterans in Primary Care: The Role of Affective Pain Interference and Alcohol Pain-Coping Perceptions. THE JOURNAL OF PAIN 2024; 25:682-689. [PMID: 37783381 DOI: 10.1016/j.jpain.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Chronic pain and unhealthy alcohol use commonly co-occur and are associated with negative health outcomes. Veterans may be particularly vulnerable to these conditions, yet limited research has examined factors involved in their co-occurrence. This cross-sectional study aimed to examine the role of affective pain interference and alcohol pain-coping perceptions in the relationship between pain and hazardous alcohol use. As informed by the catastrophizing, anxiety, negative urgency, and expectancy model, we hypothesized that the relationship between pain and hazardous alcohol consumption is mediated by affective pain interference and stronger among those with greater perceptions that alcohol helps cope with pain. Participants were 254 VA primary care patients (87.8% male, Mage = 64.03, 76.4% White) with a history of chronic musculoskeletal pain, past-year alcohol use, and past-week pain. Veterans completed a mailed survey including measures of pain, affective pain interference, alcohol pain-coping perceptions, and hazardous alcohol use. Hypotheses were tested with regression models and PROCESS macros. As hypothesized, affective pain interference mediated the pain-hazardous alcohol use association. Contrary to hypotheses, results showed no moderating effect of alcohol pain-coping perceptions. Findings partially support relationships among theorized constructs and suggest that for Veterans with co-occurring pain and alcohol use it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain. PERSPECTIVE: This article presents a test of factors involved in the pain and alcohol relationship, as informed by the CANUE model. Findings suggest that for Veterans with co-occurring pain and past-year alcohol use, it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain.
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Affiliation(s)
- Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Travis A Loughran
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York; Department of Psychology, Syracuse University, Syracuse, New York; Department of Psychiatry, University of Rochester, Rochester, New York
| | - Jacob L Scharer
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Katherine A Buckheit
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Gregory P Beehler
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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White B, Sirohi S. A Complex Interplay between Nutrition and Alcohol use Disorder: Implications for Breaking the Vicious Cycle. Curr Pharm Des 2024; 30:1822-1837. [PMID: 38797900 DOI: 10.2174/0113816128292367240510111746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Approximately 16.5% of the United States population met the diagnostic criteria for substance use disorder (SUD) in 2021, including 29.5 million individuals with alcohol use disorder (AUD). Individuals with AUD are at increased risk for malnutrition, and impairments in nutritional status in chronic alcohol users can be detrimental to physical and emotional well-being. Furthermore, these nutritional deficiencies could contribute to the never-ending cycle of alcoholism and related pathologies, thereby jeopardizing the prospects of recovery and treatment outcomes. Improving nutritional status in AUD patients may not only compensate for general malnutrition but could also reduce adverse symptoms during recovery, thereby promoting abstinence and successful treatment of AUD. In this review, we briefly summarize alterations in the nutritional status of people with addictive disorders, in addition to the underlying neurobiological mechanisms and clinical implications regarding the role of nutritional intervention in recovery from alcohol use disorder.
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Affiliation(s)
- Brooke White
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA
| | - Sunil Sirohi
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA
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Kumar N. Nutritional Neuropathies. Continuum (Minneap Minn) 2023; 29:1469-1491. [PMID: 37851039 DOI: 10.1212/con.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article reviews the etiologies, presentations, and management of neuropathies related to nutritional deficiencies. LATEST DEVELOPMENTS Peripheral neuropathy can be the predominant or only manifestation of certain nutrient deficiencies. Cognitive difficulties or involvement of other parts of the central nervous system, such as the optic nerve and spinal cord, may accompany nutritional peripheral neuropathies. In most patients, the nutritional deficiency may have a single predominant cause, but in some cases, multiple causes may coexist. Obesity, for unclear reasons, can be associated with nutrient deficiencies. The rising rates of bariatric surgery and the incidence of nutrient deficiencies following bariatric surgery make this a particularly relevant topic for neurologists. ESSENTIAL POINTS Neuropathies caused by nutrient deficiencies are preventable with appropriate supplementation in high-risk situations. Early recognition and prompt treatment are essential to ensure an optimal outcome and minimize neurologic morbidity.
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Speksnijder CM, Ortiz-Comino L, de Haan AFJ, Fernández-Lao C, de Bree R, Merkx MAW. Swallowing after Oral Oncological Treatment: A Five-Year Prospective Study. Cancers (Basel) 2023; 15:4371. [PMID: 37686646 PMCID: PMC10486578 DOI: 10.3390/cancers15174371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Swallowing rehabilitation in curative treated patients with oral cancer is still a challenge. Different factors may influence these patients' swallowing function. The aim of this study was to identify factors associated with swallowing function up to 5 years after cancer treatment. METHODS Swallowing duration and frequency of 5 mL water and 15 mL applesauce were measured in 123 patients treated for oral cancer. Mixed model analyses were performed to identify associated factors. RESULTS Age influenced all measured swallowing outcomes. Assessment moment, gender, tumor location, maximum tongue force, and tactile sensory function of the tongue were associated with both water and applesauce swallowing duration, tumor classification was associated with water swallowing duration, and alcohol consumption was associated with applesauce swallowing duration. Assessment moment, cancer treatment, maximum tongue force, and tactile sensory function of the tongue were associated with water and applesauce swallowing frequency. CONCLUSION Patients who are older at diagnosis, women, and patients who regularly consume alcohol before their treatment may have poorer swallow functioning after curative oral cancer treatment. Patients that fit these criteria should have their swallowing evaluated during clinical follow-ups and sent to swallowing therapy when needed. During this therapy, optimizing tongue function needs attention to maintain an optimal swallowing function.
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Affiliation(s)
- Caroline M. Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Lucía Ortiz-Comino
- Department of Physical Therapy, University of Granada, 18071 Granada, Spain
| | - Anton F. J. de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | | | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Matthias A. W. Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Dutch Comprehensive Cancer Centre, 3501 DB Utrecht, The Netherlands
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10
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Fernandez A, Graf G, Lasserre A, Daeppen JB, Chu Sin Chung P, Berna C, Suter MR. Somatosensory profiling of patients undergoing alcohol withdrawal: Do neuropathic pain and sensory loss represent a problem? J Peripher Nerv Syst 2023; 28:490-499. [PMID: 37419872 DOI: 10.1111/jns.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Chronic heavy alcohol use is known to cause neurological complications such as peripheral neuropathy. Concerning the pathophysiology, few sural nerve and skin biopsy studies showed that small fibers might be selectively vulnerable to degeneration in alcohol-related peripheral neuropathy. Pain has rarely been properly evaluated in this pathology. The present study aims at assessing pain intensity, potential neuropathic characteristics as well as the functionality of both small and large nerve sensitive fibers. METHODS In this observational study, 27 consecutive adult patients, hospitalized for alcohol withdrawal and 13 healthy controls were recruited. All the participants underwent a quantitative sensory testing (QST) according to the standardized protocol of the German Research Network Neuropathic Pain, a neurological examination and filled standardized questionnaires assessing alcohol consumption and dependence as well as pain characteristics and psychological comorbidities. RESULTS Nearly half of the patients (13/27) reported pain. Yet, pain intensity was weak, leading to a low interference with daily life, and its characteristics did not support a neuropathic component. A functional impairment of small nerve fibers was frequently described, with thermal hypoesthesia observed in 52% of patients. Patients with a higher alcohol consumption over the last 2 years showed a greater impairment of small fiber function. DISCUSSION Patients report pain but it is however unlikely to be caused by peripheral neuropathy given the non-length-dependent distribution and the absence of neuropathic pain features. Chronic pain in AUD deserves to be better evaluated and managed as it represents an opportunity to improve long-term clinical outcomes, potentially participating to relapse prevention.
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Affiliation(s)
- Aurore Fernandez
- Pain Center, Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Integrative and Complementary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Guillaume Graf
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Aurélie Lasserre
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Psychiatry-Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Psychiatry-Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Chu Sin Chung
- Pain Center, Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Chantal Berna
- Pain Center, Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Integrative and Complementary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc R Suter
- Pain Center, Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
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11
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Campos-Jurado Y, Morón JA. Inflammatory pain affects alcohol intake in a dose-dependent manner in male rats in the intermittent access model. Pain Rep 2023; 8:e1082. [PMID: 37388406 PMCID: PMC10306431 DOI: 10.1097/pr9.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Epidemiological studies have shown that there is a relation between pain and alcohol use disorder (AUD). Persistent pain is directly correlated with an increment in alcohol consumption and an increased risk of developing an AUD. Greater levels of pain intensity and unpleasantness are associated with higher levels of relapse, an increase in alcohol consumption, rates of hazardous drinking, and delay to seek for treatment. However, this interaction has not been deeply studied in the preclinical setting. Methods Here, we aim to evaluate how inflammatory pain affects levels of alcohol drinking in male and female rats with a history of alcohol. For that, we used an intermittent access 2-bottle choice paradigm combined with the complete Freund Adjuvant (CFA) model of inflammatory pain. Results Our results show that CFA-induced inflammatory pain does not alter total intake of 20% alcohol in male or female rats. Interestingly, in males, the presence of CFA-induced inflammatory pain blunts the decrease of alcohol intake when higher concentrations of alcohol are available, whereas it does not have an effect on intake at any concentration in female rats. Conclusion Altogether, this study provides relevant data and constitutes an important contribution to the study of pain and AUD and it highlights the necessity to design better behavioral paradigms in animal models that are more translational and reflect current epidemiological findings.
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Affiliation(s)
- Yolanda Campos-Jurado
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
- Pain Center, Washington University in St. Louis, St. Louis, MO, USA
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jose A. Morón
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
- Pain Center, Washington University in St. Louis, St. Louis, MO, USA
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Departments of Neuroscience and
- Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
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12
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Donné Gnonlonfoun D, Sowanou A, Gnigone P, Gbessemehlan A, Nyangui Mapaga J, Aballo W, Choki B, Magne J, Boumediene F, Preux PM, Houinato D. Prevalence and associated factors with peripheral neuropathies in the general population in the rural area of Adjohoun in Benin. J Clin Neurosci 2023; 109:32-38. [PMID: 36669428 DOI: 10.1016/j.jocn.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Peripheral neuropathies (PN) are a group of neurological conditions related to damage to the peripheral nervous system. Due to their wide diversity, few studies in sub-Saharan Africa have explored their epidemiology in general population. Our objective was to study the prevalence and associated factors with PN in general population in Adjohoun in Benin. METHODS A cross-sectional study has been conducted from February to March 2019 and included people aged ≥ 18 years old living in Adjohoun, Benin. Following a screening phase for PN (using World Health Organization questionnaire for major neurological diseases), a neurologist made a diagnosis after in-depth clinical examinations completed in some cases by electroneuromyography. The EFNS (European Federation of Neurological Societies) 2010 criteria was used for chronic inflammatory demyelinating polyneuropathy diagnosis. Data such as age, occupation, consanguinity, alcohol consumption, diabetes, hypertension were collected. Association between independent variables and PN were investigated using multivariable logistic regression models. RESULTS In total, 1 655 participants were included, mean age 41.4 ± 16.7 years; 64.8 % are female. The overall prevalence of PN was 6.9 % (95 %CI: 5.7 %-8.2 %). The main types of PN were: polyneuropathies 4.8 % (95 %CI: 3.8 %-5.9 %); polyradiculoneuropathies 1.6 % (95 %CI: 1.0 %-2.2 %). Factors independently associated with PN were age ≥ 40 years (adjusted Odds Ratio aOR = 19.6; 95 %CI: 8.2-46.3), diabetes (aOR = 1.8; 95 %CI: 1.08-2.99) and hypertension (aOR = 1.6; 95 %CI: 1.02-2.5). CONCLUSION The prevalence of PN was high in the rural commune of Adjohoun in Benin. Actions on its modifiable associated factors such as diabetes and hypertension could help reduce the proportion of PN and their potential harmful consequences.
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Affiliation(s)
- Dieu Donné Gnonlonfoun
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin; Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
| | - Arlos Sowanou
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Pupchen Gnigone
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Antoine Gbessemehlan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | | - Wilson Aballo
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Blaise Choki
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin; University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
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13
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Alcoholic neuropathy associated with chronic alcohol intake. IBRO Neurosci Rep 2022; 13:177-186. [PMID: 36065406 PMCID: PMC9440385 DOI: 10.1016/j.ibneur.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Alcoholic neuropathy (AN), a debilitating condition that mainly affects chronic alcohol drinkers, is thought to cause lesions in the peripheral nervous system leading to sensory, autonomic, and motor dysfunctions. Despite many studies, the pathogenesis of these lesions is still not completely understood. We investigated few aspects on the development of alcohol-induced peripheral neuropathy, by assessing sensory, motor and autonomic functions, as well as stereological analysis of axonal fibers and myelin sheath of the sciatic nerve. Twelve male Wistar rats were divided into Control group and Alcohol group that was submitted to Two Bottle-Choice Paradigm of intermittent and voluntary alcohol solution intake (20%; v/v) during eight weeks. At the end of treatment, three different sensorium-motor tests were applied - Tactile Sensitivity, Thermal Sensitivity, and Functional Observational Battery (FOB). Quantitative morphometric analysis of sciatic nerve structures was performed by stereological method. Alcohol concentration in the blood was measured to analyze possible correlation between availability of alcohol in the blood and the magnitude of the peripheral nerve lesion. Our data showed a peripheral effect of chronic alcohol intake associated with hyperalgesia and a process of demyelination with a strong correlation with alcohol consumption. This process was associated with increased tactile sensitivity, with behavioral reflexes such as locomotor hyperactivity, changes in gait and balance, and autonomic reflexes such as piloerection. Alcoholic neuropathy and its consequences. Neuropathy and sensitive and motor alterations. Alcoholic neuropathy and thinner myelin sheath thickness.
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14
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Lepić S, Lepić M, Banjanin N, Mandić-Rajčević S, Rasulić L. A review of the diet, nutrients, and supplementation potential for the outcome augmentation in surgical treatment of peripheral nerve injuries. Front Surg 2022; 9:942739. [PMID: 36439529 PMCID: PMC9683533 DOI: 10.3389/fsurg.2022.942739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/13/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Although the studies have shown the beneficial effects of diet, nutrition, and supplementation as an independent treatment modality, their roles are underestimated in the treatment of peripheral nerve injuries. This is in great part due to the development of efficient nerve repair techniques, combined with physical treatment and stimulation. To achieve the best possible functional recovery diet, nutrition, and supplementation should be implemented within a multidisciplinary approach. The aim of the study is to provide insight into the potentially beneficial effects of diet, nutrients, and supplementation, in the limitation of nerve damage and augmentation of the functional recovery after surgery in a review of human and animal studies. METHODS The data relating to the diet, nutrients, and supplementation effects on peripheral nerve injuries and their treatment was extracted from the previously published literature. RESULTS General balanced diet as well as obesity influence the initial nerve features prior to the injury. In the period following the injury, neuroprotective agents demonstrated beneficial effects prior to surgery, and immediately after the injury, while those potentiating nerve regeneration may be used after the surgical repair to complement the physical treatment and stimulation for improved functional recovery. CONCLUSIONS Standardized diet, nutrition, and supplementation recommendations and protocols may be of great importance for better nerve regeneration and functional recovery as a part of the multidisciplinary approach to achieve the best possible results in surgically treated patients with peripheral nerve injuries in the future.
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Affiliation(s)
- Sanja Lepić
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Milan Lepić
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nikolina Banjanin
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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15
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Moser SE, Brown AM, Clark BC, Arnold WD, Baumann CW. Neuromuscular mechanisms of weakness in a mouse model of chronic alcoholic myopathy. Alcohol Clin Exp Res 2022; 46:1636-1647. [PMID: 35869821 PMCID: PMC9804636 DOI: 10.1111/acer.14907] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Weakness is a common clinical symptom reported in individuals with chronic alcohol use disorder. However, it remains unclear whether low strength in these individuals is directly related to excessive ethanol intake, other deleterious factors (lifestyle, environment, genetics, etc.), or a combination of both. Therefore, we examined whether (and how) ethanol reduces the muscle's force-producing capacity using a controlled in vivo preclinical mouse model of excessive ethanol intake. METHODS To establish whether chronic ethanol consumption causes weakness, C57BL/6 female mice consumed 20% ethanol for 40 weeks (following a 2-week ethanol ramping period), and various measures of muscular force were quantified. Functional measures included all-limb grip strength and in vivo contractility of the left ankle dorsiflexors and plantarflexors. Once confirmed that mice consuming ethanol were weaker than age-matched controls, we sought to determine the potential neuromuscular mechanisms of muscle dysfunction by assessing neuromuscular excitation, muscle quantity, and muscle quality. RESULTS Mice consuming chronic ethanol were 13 to 16% weaker (p ≤ 0.016) than controls (i.e., mice consuming 100% water) with the negative impact of ethanol on voluntary grip strength (ƞ2 = 0.603) being slightly larger than that of electrically stimulated muscle contractility (ƞ2 = 0.482). Relative to controls, lean mass and muscle wet masses were 9 to 16% lower in ethanol-consuming mice (p ≤ 0.048, ƞ2 ≥ 0.268). No significant changes were observed between groups for indices of neuromuscular excitation at the level of the motor unit, neuromuscular junction, or plasmalemma (p ≥ 0.259, ƞ2 ≤ 0.097), nor was muscle quality altered after 40 weeks of 20% ethanol consumption (p ≥ 0.695, ƞ2 ≤ 0.012). CONCLUSIONS Together, these findings establish that chronic ethanol consumption in mice induces a substantial weakness in vivo that we interpret to be primarily due to muscle atrophy (i.e., reduced muscle quantity) and possibly, to a lesser degree, loss of central neural drive.
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Affiliation(s)
- Samantha E. Moser
- Honors Tutorial CollegeOhio UniversityAthensOhioUSA,Ohio Musculoskeletal and Neurological Institute (OMNI)Ohio UniversityAthensOhioUSA
| | - Austin M. Brown
- Honors Tutorial CollegeOhio UniversityAthensOhioUSA,Ohio Musculoskeletal and Neurological Institute (OMNI)Ohio UniversityAthensOhioUSA
| | - Brian C. Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI)Ohio UniversityAthensOhioUSA,Department of Biomedical SciencesOhio UniversityAthensOhioUSA
| | - W. David Arnold
- Department of NeurologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA,Department of Physical Medicine and RehabilitationThe Ohio State University Wexner Medical CenterColumbusOhioUSA,Department of NeuroscienceThe Ohio State University Wexner Medical CenterColumbusOhioUSA,Department of Physiology and Cell BiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Cory W. Baumann
- Ohio Musculoskeletal and Neurological Institute (OMNI)Ohio UniversityAthensOhioUSA,Department of Biomedical SciencesOhio UniversityAthensOhioUSA
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16
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Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, Teresiński G, Buszewicz G, Januszewski J, Flieger J. Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053092. [PMID: 35270784 PMCID: PMC8910489 DOI: 10.3390/ijerph19053092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.
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Affiliation(s)
- Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
- Correspondence:
| | - Joanna Kobak
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Magdalena Tyczyńska
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Iga Dudek
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Amr Maani
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Grzegorz Buszewicz
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jacek Januszewski
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland;
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17
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Assaker R, El Hasbani G, Antezana AA, Gamarra JV, Amaya-Suarez J, Bertely C, Suleman N. I drank too much and now I can't walk: a case of alcohol-induced dysautonomia. Oxf Med Case Reports 2021; 2021:omab072. [PMID: 34408893 PMCID: PMC8366070 DOI: 10.1093/omcr/omab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/24/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Dysautonomia is a dysfunction of the autonomic nervous system, which mediates both sympathetic and parasympathetic functions of the human body. Alcohol has been established to affect the autonomic function through liver injury and accumulation of vasodilators. Alcohol can induce peripheral neurological diseases as well. This case report describes a patient who had a chronic history of alcoholism and uncontrolled diabetes mellitus presenting for orthostatic hypotension and peripheral neuropathy without underlying liver disease or other endocrinopathies. Although diabetes mellitus was controlled pharmacologically and risk factors for orthostatic hypotension were managed conservatively, his symptoms did not improve which indicated an alcohol-related autonomic dysfunction, shedding light on one of long-term complications of alcoholism.
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18
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A Retrospective Analysis of Pain Etiology in Middle-Aged Patients with Peripheral Neuropathy. ACTA ACUST UNITED AC 2021; 57:medicina57080787. [PMID: 34440993 PMCID: PMC8399428 DOI: 10.3390/medicina57080787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
Background and Objectives: Correct assessment and a multidisciplinary approach appear to be extremely important in preventing peripheral neuropathy and its complications. The purpose of this study was to find the correlations and dissimilarities between different types of peripheral neuropathy, the occurrence of pain, and laboratory results. Materials and Methods: This retrospective study assessed 124 patients who were hospitalized in our neurology department due to various types of sensory or motor disturbances. The patients were eventually diagnosed with peripheral neuropathy, based on the electrophysiological study, anamnesis, physical examination, and laboratory results. The whole group was subjected to statistical analysis. Results: The mean age of patients was over 56 years, with a slight woman predominance. A statistically significant (p < 0.05) relationship between the place of residence and gender was seen, where more men than women live in the rural area, while more women than men live in the urban area. Most often we observed symmetric, sensorimotor, demyelinating, inflammatory, and chronic neuropathy. More than 40% of patients reported pain. A statistically significant correlation between the evolution/severity and the occurrence of pain was seen in subacute type (p < 0.05) and small fibre neuropathy (p < 0.01). Conclusions: A higher incidence of peripheral neuropathy in middle-aged people will become essential in the aging society with lifestyle and chronic disorders. Peripheral neuropathy is slightly more common in women than men and its occurrence may be influenced by work performed or internal and external factors. In the study group, more than 40% of patients reported pain, therefore the pain measurement for each patient should be implemented and repeated at every visit. An assessment of sodium level and, in women, markers of neuroinflammation level in the various types of peripheral neuropathy may be an interesting direction for the future.
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19
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Phan KH, Anderson JG, Bohay DR. Complications Associated with Peripheral Nerve Blocks. Orthop Clin North Am 2021; 52:279-290. [PMID: 34053573 DOI: 10.1016/j.ocl.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient orthopedic surgery is gradually becoming the standard across the country, as it has been found to significantly lower costs without compromising patient care. Peripheral nerve blocks (PNBs) are largely what have made this transition possible by providing patients excellent pain control in the immediate postoperative period. However, with the increasing use of PNBs, it is important to recognize that they are not without complications. Although rare, these complications can cause patients a significant amount of morbidity. It is important for surgeons to know the risks of peripheral nerve blocks and to inform their patients.
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Affiliation(s)
- Kevin H Phan
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA.
| | - John G Anderson
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA
| | - Donald R Bohay
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA
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20
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Tarulli A. Distal and Generalized Sensory Symptoms. Neurology 2021. [DOI: 10.1007/978-3-030-55598-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Simo N, Kuate-Tegueu C, Ngankou-Tchankeu S, Doumbe J, Maiga Y, Cesari M, Dartigues JF, Kengne AP, Tabue-Teguo M. Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa. PLoS One 2020; 15:e0240602. [PMID: 33119646 PMCID: PMC7595408 DOI: 10.1371/journal.pone.0240602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults. Methods Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16. Results A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes. Conclusion A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.
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Affiliation(s)
- Nadine Simo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
| | - Callixte Kuate-Tegueu
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaounde, Cameroon
| | - Steve Ngankou-Tchankeu
- Institut Supérieur des Sciences de la Santé, Université des Montagnes, Bangangté, Cameroun
| | - Jacques Doumbe
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Youssoufa Maiga
- Service de Neurologie, Hôpital Gabriel Toure (CHU), Bamako, Mali
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Andre-Pascal Kengne
- South African Medical Research Council of South Africa, Cape Town, South Africa
| | - Maturin Tabue-Teguo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
- INSERM U 1219, Université de Bordeaux, Bordeaux, France
- * E-mail:
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22
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Alcohol-Induced Neuropathy in Chronic Alcoholism: Causes, Pathophysiology, Diagnosis, and Treatment Options. CURRENT PATHOBIOLOGY REPORTS 2020. [DOI: 10.1007/s40139-020-00214-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Purpose of the Review
Alcohol abuse causes a wide range of disorders that affect the nervous system. These include confusion, cerebellar ataxia, peripheral neuropathy, and cognitive impairment. Chronic and excessive alcohol consumption is the primary cause of peripheral neuropathy. It is worth noting that peripheral neuropathy has no reliable treatment due to the poor understanding of its pathology.
Recent Findings
Coasting is a major feature of alcoholic neuropathy, largely due to chronic alcohol abuse. Its major features are hyperalgesia, allodynia, and burning pain. Even though much research was done in this area, still we do not have a full understanding of the mechanism of alcoholic neuropathy. However, some theories have been proposed. These include direct or indirect effects of alcohol metabolites, impaired axonal transport, suppressed excitatory nerve pathway activity, or imbalance in neurotransmitters. Activation of spinal cord microglia, mGlu5 spinal cord receptors, and hypothalamic-pituitary-adrenal axis also seem to be implicated in the pathophysiology of this alcoholic neuropathy. The goal of treatment is to impede further damage to the peripheral nerves while also restoring their normal physiology. Alcohol abstinence, intake of balanced diets, and treatment with medications are suggested including benfotiamine, alpha-lipoic acid, acetyl-l-carnitine, vitamin E, methylcobalamin, myo-inositol, N-acetylcysteine, capsaicin, tricyclic antidepressants, or antiepileptic drugs.
Summary
This review focuses on the many pathways that play a role in the onset and development of alcohol-induced neuropathy, as well as present the possible treatment strategies of this disorder, providing insights into a further search of new treatment modalities.
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Abstract
Peripheral neuropathies secondary to neurotoxicants are frequently considered but can be difficult to diagnose. Accurate diagnosis is important to avoid unnecessary testing, prevent further exposure, and initiate treatment when available. This article reviews key features of some of the more common or representative toxic neuropathies, including those caused by occupational and environmental exposure, medications, and chemotherapeutic agents.
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Affiliation(s)
- Michel Toledano
- Department of Neurology, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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24
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Transcranial Direct Current Stimulation (tDCS) Induces Analgesia in Rats with Neuropathic Pain and Alcohol Abstinence. Neurochem Res 2020; 45:2653-2663. [DOI: 10.1007/s11064-020-03116-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
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25
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Lorente JD, Cuitavi J, Campos-Jurado Y, Hipólito L. Pain-induced alterations in the dynorphinergic system within the mesocorticolimbic pathway: Implication for alcohol addiction. J Neurosci Res 2020; 100:165-182. [PMID: 32770601 DOI: 10.1002/jnr.24703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
Latest studies have revealed that pain negatively impacts on reward processing and motivation leading to negative affective states and stress. These states not only reduce quality of life of patients by increasing the appearance of psychiatric comorbidities, but also have an important impact on vulnerability to drug abuse, including alcohol. In fact, clinical, epidemiological but also preclinical studies have revealed that the presence of pain is closely related to alcohol use disorders (AUDs). All this evidence suggests that pain is a factor that increases the risk of suffering AUD, predicting heavy drinking behavior and relapse drinking in those patients with a previous history of AUD. The negative consequences of chronic pain and its impact on stress and AUD are likely mediated by alterations in the central nervous system, especially in the stress and reward systems. Therefore, pain and stress impact on dopaminergic mesolimbic pathway can lead to an increase in drug abuse liability. In this mini review we analyze the interaction between pain, stress, and alcohol addiction, and how dynamic changes in the kappa opioid system might play a crucial role in the development of compulsive alcohol drinking in chronic pain patients.
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Affiliation(s)
- Jesús David Lorente
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of València, Burjassot, Spain
| | - Javier Cuitavi
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of València, Burjassot, Spain
| | - Yolanda Campos-Jurado
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of València, Burjassot, Spain
| | - Lucía Hipólito
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of València, Burjassot, Spain
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A Survey Study of Health Promotion, Wellness, and Prevention in Wound Management Environments. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Erlangsen A, Stenager E, Conwell Y, Andersen PK, Hawton K, Benros ME, Nordentoft M, Stenager E. Association Between Neurological Disorders and Death by Suicide in Denmark. JAMA 2020; 323:444-454. [PMID: 32016308 PMCID: PMC7042859 DOI: 10.1001/jama.2019.21834] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Neurological disorders have been linked to suicide, but the risk across a broad spectrum of neurological disorders remains to be assessed. OBJECTIVES To examine whether people with neurological disorders die by suicide more often than other people and to assess for temporal associations. DESIGN, SETTING, AND PARTICIPANTS Nationwide, retrospective cohort study on all persons 15 years or older living in Denmark, from 1980 through 2016 (N = 7 300 395). EXPOSURES Medical contact for head injury, stroke, epilepsy, polyneuropathy, diseases of myoneural junction, Parkinson disease, multiple sclerosis, central nervous system infections, meningitis, encephalitis, amyotrophic lateral sclerosis, Huntington disease, dementia, intellectual disability, and other brain diseases from 1977 through 2016 (n = 1 248 252). MAIN OUTCOMES AND MEASURES Death by suicide during 1980-2016. Adjusted incidence rate ratio (IRRs) were estimated using Poisson regressions, adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and self-harm. RESULTS Of the more than 7.3 million individuals observed over 161 935 233 person-years (49.1% males), 35 483 died by suicide (median duration of follow-up, 23.6 years; interquartile range, 10.0-37.0 years; mean age, 51.9 years; SD, 17.9 years). Of those, 77.4% were males, and 14.7% (n = 5141) were diagnosed with a neurological disorder, equivalent to a suicide rate of 44.0 per 100 000 person-years compared with 20.1 per 100 000 person-years among individuals not diagnosed with a neurological disorder. People diagnosed with a neurological disorder had an adjusted IRR of 1.8 (95% CI, 1.7-1.8) compared with those not diagnosed. The excess adjusted IRRs were 4.9 (95% CI, 3.5-6.9) for amyotrophic lateral sclerosis, 4.9 (95% CI, 3.1-7.7) for Huntington disease, 2.2 (95% CI, 1.9-2.6) for multiple sclerosis, 1.7 (95% CI, 1.6-1.7) for head injury, 1.3 (95% CI, 1.2-1.3) for stroke, and 1.7 (95% CI, 1.6-1.8) for epilepsy. The association varied according to time since diagnosis with an adjusted IRR for 1 to 3 months of 3.1 (95% CI, 2.7-3.6) and for 10 or more years, 1.5 (95% CI, 1.4 to 1.6, P < .001). Compared with those who were not diagnosed with a neurological disorder, those with dementia had a lower overall adjusted IRR of 0.8 (95% CI, 0.7-0.9), which was elevated during the first month after diagnosis to 3.0 (95% CI, 1.9-4.6; P < .001). The absolute risk of suicide for people with Huntington disease was 1.6% (95% CI, 1.0%-2.5%). CONCLUSIONS AND RELEVANCE In Denmark from 1980 through 2016, there was a significantly higher rate of suicide among those with a diagnosed neurological disorder than persons not diagnosed with a neurological disorder. However, the absolute risk difference was small.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Focused Research Unit, Department of Psychiatry, University Hospital of the Region of Southern Denmark, Aabenraa
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Egon Stenager
- MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Hospital of Southern Jutland, Sønderborg, Denmark
- Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense
- Focused Research Unit, Center Sønderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York
| | | | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warnerford Hospital, Oxford, United Kingdom
| | - Michael Eriksen Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Stenager
- Focused Research Unit, Department of Psychiatry, University Hospital of the Region of Southern Denmark, Aabenraa
- Department of Regional Health Research, University of Southern Denmark, Odense
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Abstract
Toxic peripheral neuropathies are an important form of acquired polyneuropathy produced by a variety of xenobiotics and different exposure scenarios. Delineating the mechanisms of neurotoxicants and determining the degenerative biological pathways triggered by peripheral neurotoxicants will facilitate the development of sensitive and specific biochemical-based methods for identifying neurotoxicants, designing therapeutic interventions, and developing structure-activity relationships for predicting potential neurotoxicants. This review presents an overview of the general concepts of toxic peripheral neuropathies with the goal of providing insight into why certain agents target the peripheral nervous system and produce their associated lesions. Experimental data and the main hypotheses for the mechanisms of selected agents that produce neuronopathies, axonopathies, or myelinopathies including covalent or noncovalent modifications, compromised energy or protein biosynthesis, and oxidative injury and disruption of ionic gradients across membranes are presented. The relevance of signaling between the main components of peripheral nerve, that is, glia, neuronal perikaryon, and axon, as a target for neurotoxicants and the contribution of active programmed degenerative pathways to the lesions observed in toxic peripheral neuropathies is also discussed.
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Eldridge S, Guo L, Hamre J. A Comparative Review of Chemotherapy-Induced Peripheral Neuropathy in In Vivo and In Vitro Models. Toxicol Pathol 2020; 48:190-201. [PMID: 31331249 PMCID: PMC6917839 DOI: 10.1177/0192623319861937] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect caused by several classes of widely used anticancer therapeutics. Chemotherapy-induced peripheral neuropathy frequently leads to dose reduction or discontinuation of chemotherapy regimens, and CIPN symptoms can persist long after completion of chemotherapy and severely diminish the quality of life of patients. Differences in the clinical presentation of CIPN by widely diverse classifications of anticancer agents have spawned multiple mechanistic hypotheses that seek to explain the pathogenesis of CIPN. Despite its clinical relevance, common occurrence, and extensive investigation, the pathophysiology of CIPN remains unclear. Furthermore, there is no unequivocal gold standard for the prevention and treatment of CIPN. Herein, we review in vivo and in vitro models of CIPN with a focus on histopathological changes and morphological features aimed at understanding the pathophysiology of CIPN and identify gaps requiring deeper exploration. An elucidation of the underlying mechanisms of CIPN is imperative to identify potential targets and approaches for prevention and treatment.
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Affiliation(s)
- Sandy Eldridge
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Liang Guo
- Laboratory of Investigative Toxicology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - John Hamre
- Laboratory of Investigative Toxicology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
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Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2019; 62:13-29. [PMID: 31837157 DOI: 10.1002/mus.26783] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
Neuropathies associated with nutritional deficiencies are routinely encountered by the practicing neurologist. Although these neuropathies assume different patterns, most are length-dependent, sensory axonopathies. Cobalamin deficiency neuropathy is the exception, often presenting with a non-length-dependent sensory neuropathy. Patients with cobalamin and copper deficiency neuropathy characteristically have concomitant myelopathy, whereas vitamin E deficiency is uniquely associated with a spinocerebellar syndrome. In contrast to those nutrients for which deficiencies produce neuropathies, pyridoxine toxicity results in a non-length-dependent sensory neuronopathy. Deficiencies occur in the context of malnutrition, malabsorption, increased nutrient loss (such as with dialysis), autoimmune conditions such as pernicious anemia, and with certain drugs that inhibit nutrient absorption. When promptly identified, therapeutic nutrient supplementation may result in stabilization or improvement of these neuropathies.
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Affiliation(s)
| | - James Grogan
- University of Virginia, Charlottesville, Virginia
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De Logu F, Li Puma S, Landini L, Portelli F, Innocenti A, de Araujo DSM, Janal MN, Patacchini R, Bunnett NW, Geppetti P, Nassini R. Schwann cells expressing nociceptive channel TRPA1 orchestrate ethanol-evoked neuropathic pain in mice. J Clin Invest 2019; 129:5424-5441. [PMID: 31487269 PMCID: PMC6877331 DOI: 10.1172/jci128022] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022] Open
Abstract
Excessive alcohol consumption is associated with spontaneous burning pain, hyperalgesia, and allodynia. Although acetaldehyde has been implicated in the painful alcoholic neuropathy, the mechanism by which the ethanol metabolite causes pain symptoms is unknown. Acute ethanol ingestion caused delayed mechanical allodynia in mice. Inhibition of alcohol dehydrogenase (ADH) or deletion of transient receptor potential ankyrin 1 (TRPA1), a sensor for oxidative and carbonyl stress, prevented allodynia. Acetaldehyde generated by ADH in both liver and Schwann cells surrounding nociceptors was required for TRPA1-induced mechanical allodynia. Plp1-Cre Trpa1fl/fl mice with a tamoxifen-inducible specific deletion of TRPA1 in Schwann cells revealed that channel activation by acetaldehyde in these cells initiates a NADPH oxidase-1-dependent (NOX1-dependent) production of hydrogen peroxide (H2O2) and 4-hydroxynonenal (4-HNE), which sustains allodynia by paracrine targeting of nociceptor TRPA1. Chronic ethanol ingestion caused prolonged mechanical allodynia and loss of intraepidermal small nerve fibers in WT mice. While Trpa1-/- or Plp1-Cre Trpa1fl/fl mice did not develop mechanical allodynia, they did not show any protection from the small-fiber neuropathy. Human Schwann cells express ADH/TRPA1/NOX1 and recapitulate the proalgesic functions of mouse Schwann cells. TRPA1 antagonists might attenuate some symptoms of alcohol-related pain.
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Affiliation(s)
- Francesco De Logu
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Simone Li Puma
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Landini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Portelli
- Histopathology and Molecular Diagnostics, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Daniel Souza Monteiro de Araujo
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
- Department of Neurobiology and Program of Neurosciences, Institute of Biology, Fluminense Federal University, Niterói, Brazil
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York, USA
| | - Riccardo Patacchini
- Department of Corporate Drug Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Nigel W. Bunnett
- Department of Surgery and
- Department of Pharmacology, Columbia University in the City of New York, New York, New York, USA
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Romina Nassini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
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Taams NE, Voortman T, Hanewinckel R, Drenthen J, van Doorn PA, Ikram MA. Diet quality and chronic axonal polyneuropathy: a population-based study. Ann Clin Transl Neurol 2019; 6:2460-2467. [PMID: 31738024 PMCID: PMC6917319 DOI: 10.1002/acn3.50939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/16/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the association between diet quality and chronic axonal polyneuropathy. METHODS Between June 2013 and January 2017, among 1650 participants of the Rotterdam Study (median age 69.1 years, 54.2% women), diet quality was quantified based on food frequency questionnaires as a sum score of adherence (yes/no) to 14 components of the Dutch dietary guidelines. Presence of polyneuropathy was determined based on a questionnaire, neurological examination of the legs, and nerve conduction studies. We used logistic regression to associate diet quality with the presence of chronic axonal polyneuropathy and linear regression to associate with sural sensory nerve action potential (SNAP) amplitude in participants without polyneuropathy. Results were adjusted for age, sex, time between measurements, body mass index, blood pressure, diabetes mellitus, smoking, kidney function, and education. RESULTS Overall diet quality was not associated with chronic axonal polyneuropathy (odds ratio [OR] = 0.99, 95% confidence interval [CI] 0.88; 1.12, P = 0.842), nor with sural SNAP amplitude in participants without polyneuropathy (difference = 0.01, 95% CI -0.14; 0.15, P = 0.993). Although not surviving multiple testing, a nominally significant association was found between salt intake ≤6 g/day and presence of chronic axonal polyneuropathy (OR = 0.55, 95% CI 0.35; 0.86, P = 0.008). INTERPRETATION We did not find an association between diet quality and chronic axonal polyneuropathy.
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Affiliation(s)
- Noor E Taams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rens Hanewinckel
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Judith Drenthen
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Clinical Neurophysiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Central Nervous System Correlates of "Objective" Neuropathy in Alcohol Use Disorder. Alcohol Clin Exp Res 2019; 43:2144-2152. [PMID: 31386216 PMCID: PMC6779503 DOI: 10.1111/acer.14162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Among the neurological consequences of alcoholism is peripheral neuropathy. Relative to human immunodeficiency virus (HIV) or diabetes-related neuropathies, neuropathy associated with alcohol use disorders (AUD) is understudied. In both the diabetes and HIV literature, emerging evidence supports a central nervous system (CNS) component to peripheral neuropathy. METHODS In seeking a central substrate for AUD-related neuropathy, the current study was conducted in 154 individuals with AUD (43 women, age 21 to 74 years) and 99 healthy controls (41 women, age 21 to 77 years) and explored subjective symptoms (self-report) and objective signs (perception of vibration, deep tendon ankle reflex, position sense, 2-point discrimination) of neuropathy separately. In addition to regional brain volumes, risk factors for AUD-related neuropathy, including age, sex, total lifetime ethanol consumed, nutritional indices (i.e., thiamine, folate), and measures of liver integrity (i.e., γ-glutamyltransferase), were evaluated. RESULTS The AUD group described more subjective symptoms of neuropathy and was more frequently impaired on bilateral perception of vibration. From 5 correlates, the number of AUD-related seizures was most significantly associated with subjective symptoms of neuropathy. There were 15 correlates of impaired perception of vibration among the AUD participants: Of these, age and volume of frontal precentral cortex were the most robust predictors. CONCLUSIONS This study supports CNS involvement in objective signs of neuropathy in AUD.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Kilian M Pohl
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Adolf Pfefferbaum
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
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Calderón-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther 2019; 26:5-13. [PMID: 31490017 PMCID: PMC6930825 DOI: 10.1111/cns.13207] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background Neurotropic B vitamins play crucial roles as coenzymes and beyond in the nervous system. Particularly vitamin B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) contribute essentially to the maintenance of a healthy nervous system. Their importance is highlighted by many neurological diseases related to deficiencies in one or more of these vitamins, but they can improve certain neurological conditions even without a (proven) deficiency. Aim This review focuses on the most important biochemical mechanisms, how they are linked with neurological functions and what deficits arise from malfunctioning of these pathways. Discussion We discussed the main role of B Vitamins on several functions in the peripheral and central nervous system (PNS and CNS) including cellular energetic processes, antioxidative and neuroprotective effects, and both myelin and neurotransmitter synthesis. We also provide an overview of possible biochemical synergies between thiamine, pyridoxine, and cobalamin and discuss by which major roles each of them may contribute to the synergy and how these functions are inter‐related and complement each other. Conclusion Taking into account the current knowledge on the neurotropic vitamins B1, B6, and B12, we conclude that a biochemical synergy becomes apparent in many different pathways in the nervous system, particularly in the PNS as exemplified by their combined use in the treatment of peripheral neuropathy.
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Affiliation(s)
- Carlos Alberto Calderón-Ospina
- Center for Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mauricio Orlando Nava-Mesa
- Neuroscience Research Group (NEUROS), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Crowell KT, Laufenberg LJ, Lang CH. Chronic Alcohol Consumption, but not Acute Intoxication, Decreases In Vitro Skeletal Muscle Contractile Function. Alcohol Clin Exp Res 2019; 43:2090-2099. [PMID: 31411733 DOI: 10.1111/acer.14179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Skeletal muscle myopathy accompanying chronic alcohol misuse results in part from a decrease in protein synthesis typically observed in type II-rich muscles that leads to muscle weakness. However, there is a paucity of studies investigating whether the alcohol-induced weakness is intrinsic to the muscle or results primarily from the loss of muscle mass. The present study determines whether acute alcohol (ethanol) intoxication or chronic alcohol consumption decreases the intrinsic contractile function of muscle. METHODS Adult male mice were randomly assigned to the chronic alcohol group or given a binge dose of alcohol, and contractile characteristics of the extensor digitorum longus (EDL) were determined in vitro. RESULTS The weight and physiological cross-sectional area (PCSA) of the EDL were decreased in alcohol-fed mice. Maximum twitch and tetanic tension were also reduced, and there was a downward shift of the absolute force-frequency curve in alcohol-fed mice. However, no alcohol-induced changes were noted when these contractile parameters were normalized for the lower PCSA. Alcohol-fed mice demonstrated greater fatigability, and alcohol-induced decreases in postfatigue specific twitch and tetanic force were independent of a decreased PCSA. Furthermore, postfatigue recovery of muscle force over time was reduced. While alcohol did not alter the content of high-energy phosphates or oxidative phosphorylation complexes I-V, it did reduce myosin heavy chain and troponin-T content. In contrast, contractile properties were not altered when examined 2 hours after binge alcohol. CONCLUSIONS These data demonstrate chronic alcohol consumption decreases isometric and tetanic tension development due to a reduction in muscle CSA, whereas the increased fatigability observed was independent of muscle mass. As none of the functional changes were produced by acute alcohol, which produced higher blood alcohol levels than chronic ingestion, our data suggest defects in intrinsic muscle contractility require sustained intake and appear independent of defects in basal energy production.
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Affiliation(s)
- Kristin T Crowell
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Lacee J Laufenberg
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Charles H Lang
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, Pennsylvania.,Department of Cellular and Molecular Physiology, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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Camargo CRSD, Schoueri JHM, Alves BDCA, Veiga GRLD, Fonseca FLA, Bacci MR. Uremic neuropathy: an overview of the current literature. ACTA ACUST UNITED AC 2019; 65:469-474. [PMID: 30994849 DOI: 10.1590/1806-9282.65.3.469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy (UN) is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
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Affiliation(s)
| | | | | | | | - Fernando L A Fonseca
- Laboratory of Clinical Analysis, ABC Medical School, Santo André, SP, Brasil.,Pharmaceutical Sciences Department, Federal University of São Paulo, Diadema, SP, Brasil
| | - Marcelo R Bacci
- Department of Integrated Clinical Discussions, ABC Medical School, Santo André, SP, Brasil
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Camargo CRD, Schoueri JHM, Alves BDCA, Veiga GRLD, Fonseca FLA, Bacci MR. Uremic neuropathy: an overview of the current literature. ACTA ACUST UNITED AC 2019; 65:281-286. [PMID: 30892456 DOI: 10.1590/1806-9282.65.2.281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
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Affiliation(s)
- Celeste R de Camargo
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Jean H M Schoueri
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Beatriz da Costa Aguiar Alves
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Glaucia R L da Veiga
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Fernando L A Fonseca
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil.,Pharmaceutical Sciences Department, Federal University of São Paulo, R. Prof. Arthur Riedel, 275, CEP 09972-270 Diadema, São Paulo, Brasil
| | - Marcelo R Bacci
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
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Murphy SL, Tapper EB, Blackwood J, Richardson JK. Why Do Individuals with Cirrhosis Fall? A Mechanistic Model for Fall Assessment, Treatment, and Research. Dig Dis Sci 2019; 64:316-323. [PMID: 30327964 DOI: 10.1007/s10620-018-5333-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2018] [Indexed: 12/12/2022]
Abstract
Falls are prevalent for people with cirrhosis and commonly lead to loss of independence, reduced quality of life, and mortality. Despite a critical need for fall prevention in this population, cirrhosis-specific fall-related mechanisms are not well understood. We posit that most falls in this patient population are due to a coalescence of discrete subclinical impairments that are not typically detected at the point of care. The combined effect of these subtle age- and disease-related neurocognitive and muscular impairments leads to the inability to respond successfully to a postural perturbation within the available 300 to 400 ms. This article provides a conceptual model of physiological resilience to avoid a fall that focuses on attributes that underlie the ability to withstand a postural perturbation and their clinical evaluation. Evidence supporting this model in cirrhosis and other high fall risk conditions will be synthesized and suggestions for fall assessment and treatment will be discussed.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 344, Ann Arbor, MI, 48106, USA. .,Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA.
| | - Elliot B Tapper
- Department of Internal Medicine, Division of Gasteroenterology, University of Michigan, Ann Arbor, MI, USA. .,Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA.
| | - Jennifer Blackwood
- Department of Physical Therapy, University of Michigan - Flint Campus, Flint, MI, USA
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Abstract
Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Clinical manifestations include cerebellar ataxia, peripheral neuropathy and Wernicke-Korsakoff encephalopathy. Continued exploration of the pathophysiologic mechanisms may lead to the discovery of early interventions that can prevent permanent neurologic injury.
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Affiliation(s)
- Nadia Hammoud
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge Street, 9th Floor, MS: BCM609, Houston, TX 77030, USA
| | - Joohi Jimenez-Shahed
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, 7200 Cambridge Street, 9th Floor, MS:BCM609, Houston, TX 77030, USA.
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Abstract
PURPOSE OF REVIEW This article provides an update on the clinical presentation and management of neurologic disease related to key nutrient deficiencies. RECENT FINDINGS Major advances have been made in understanding the pathway related to vitamin B12 absorption and distribution. It is now known that deficiencies of vitamin B12 and copper have similar neurologic manifestations. Bariatric surgery is a risk factor for both. Alcoholism is just one of the many causes of thiamine deficiency. Early neurologic complications following bariatric surgery are often due to thiamine deficiency. Encephalopathy in the setting of alcoholism that persists despite thiamine replacement should prompt consideration of niacin deficiency. Pyridoxine deficiency and toxicity both have neurologic sequelae. Vitamin D deficiency and the risk for multiple sclerosis has been an area of ongoing research. SUMMARY Optimal functioning of the nervous system is dependent on a constant supply of certain vitamins and nutrients. This article discusses neurologic manifestations related to deficiency of these key nutrients.
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Re-emergence of thiamine deficiency disease in the Pacific islands (2014-15): A case-control study. PLoS One 2018; 13:e0198590. [PMID: 29879174 PMCID: PMC5991702 DOI: 10.1371/journal.pone.0198590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background From late 2014 multiple atolls in Kiribati reported an unusual and sometimes fatal illness. We conducted an investigation to identify the etiology of the outbreak on the most severely affected atoll, Kuria, and identified thiamine deficiency disease as the cause. Thiamine deficiency disease has not been reported in the Pacific islands for >5 decades. We present the epidemiological, clinical, and laboratory findings of the investigation. Methodology/Principal findings We initially conducted detailed interviews and examinations on previously identified cases to characterize the unknown illness and develop a case definition. Active and passive surveillance was then conducted to identify additional cases. A questionnaire to identify potential risk factors and blood samples to assay biochemical indices were collected from cases and asymptomatic controls. Thiamine hydrochloride treatment was implemented and the response to treatment was systematically monitored using a five-point visual analogue scale and by assessing resolution of previously abnormal neurological examination findings. Risk factors and biochemical results were assessed by univariate and multivariate analyses. 69 cases were identified on Kuria (7% attack rate) including 34 confirmed and 35 unconfirmed. Most were adults (median age 28 years [range 0–62]) and 83% were male. Seven adult males and two infants died (13% case fatality rate). Resolution of objective clinical signs (78%) or symptoms (94%) were identified within one week of starting treatment. Risk factors included having a friend with thiamine deficiency disease and drinking kava; drinking yeast alcohol reduced the risk of disease. Higher chromium (p<0·001) but not thiamine deficiency (p = 0·66) or other biochemical indices were associated with disease by univariate analyses. Chromium (p<0·001) and thiamine deficiency (p = 0·02) were associated with disease by multivariate analysis. Conclusions/Significance An outbreak of thiamine deficiency disease (beriberi) in Kiribati signals the re-emergence of a classic nutritional disease in the Pacific islands after five decades. Although treatment is safe and effective, the underlying reason for the re-emergence remains unknown. Chromium was highly and positively correlated with disease in this study raising questions about the potential role of factors other than thiamine in the biochemistry and pathophysiology of clinical disease.
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Sárközi A, Cseh D, Gerlei Z, Kollai M. Reduced neural baroreflex sensitivity is related to enhanced endothelial function in patients with end-stage liver disease. Scand J Gastroenterol 2018; 53:193-199. [PMID: 29272958 DOI: 10.1080/00365521.2017.1401118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Reduced baroreflex sensitivity (BRS) is a frequent complication in end-stage liver disease, but the underlying mechanism is unknown. We investigated the mechanical and neural components of BRS. Increased nitric oxide (NO) production has been reported in end-stage liver failure. Based on earlier experiments, we hypothesised that enhanced endothelial function might affect baroreflex function. Therefore, we explored the relation between endothelial function and the components of BRS. MATERIALS AND METHODS We enrolled 24 patients and 23 controls. BRS was determined by the spontaneous sequence method. Mechanical component was characterised by the distensibility coefficient (DC) of common carotid artery. Neural component was estimated as the ratio of integrated BRS and DC. Endothelial function was quantified by flow-mediated dilation (FMD) of the brachial artery. RESULTS Integrated BRS was reduced in patients [7.00 (5.80-9.25) vs. 11.1 (8.50-14.80) ms/mmHg]. The mechanical component was not different in the two groups, whereas neural component showed significant reduction in patients (3.54 ± 1.20 vs. 4.48 ± 1.43 ms/10-3). FMD was higher in patients (9.81 ± 3.77 vs. 5.59 ± 1.36%). FMD and neural BRS were directly related in controls (r = 0.62), but inversely related in patients (r = -0.49). CONCLUSIONS Baroreflex impairment in end-stage liver disease might be explained by deterioration of the neural component, while the mechanical component appears to be preserved. Endothelial NO may enhance BRS in health; however, central endothelial overproduction of NO likely contributes to the reduction of neural component of BRS in patients awaiting liver transplantation.
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Affiliation(s)
- Adrienn Sárközi
- a Department of Physiology , Semmelweis University , Budapest , Hungary
| | - Domonkos Cseh
- a Department of Physiology , Semmelweis University , Budapest , Hungary
| | - Zsuzsanna Gerlei
- b Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Márk Kollai
- a Department of Physiology , Semmelweis University , Budapest , Hungary
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Dolan ME, El Charif O, Wheeler HE, Gamazon ER, Ardeshir-Rouhani-Fard S, Monahan P, Feldman DR, Hamilton RJ, Vaughn DJ, Beard CJ, Fung C, Kim J, Fossa SD, Hertz DL, Mushiroda T, Kubo M, Einhorn LH, Cox NJ, Travis LB. Clinical and Genome-Wide Analysis of Cisplatin-Induced Peripheral Neuropathy in Survivors of Adult-Onset Cancer. Clin Cancer Res 2017; 23:5757-5768. [PMID: 28611204 PMCID: PMC5626588 DOI: 10.1158/1078-0432.ccr-16-3224] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/17/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022]
Abstract
Purpose: Our purpose was to characterize the clinical influences, genetic risk factors, and gene mechanisms contributing to persistent cisplatin-induced peripheral neuropathy (CisIPN) in testicular cancer survivors (TCSs).Experimental Design: TCS given cisplatin-based therapy completed the validated EORTC QLQ-CIPN20 questionnaire. An ordinal CisIPN phenotype was derived, and associations with age, smoking, excess drinking, hypertension, body mass index, diabetes, hypercholesterolemia, cumulative cisplatin dose, and self-reported health were examined for 680 TCS. Genotyping was performed on the Illumina HumanOmniExpressExome chip. Following quality control and imputation, 5.1 million SNPs in 680 genetically European TCS formed the input set. GWAS and PrediXcan were used to identify genetic variation and genetically determined gene expression traits, respectively, contributing to CisIPN. We evaluated two independent datasets for replication: Vanderbilt's electronic health database (BioVU) and the CALGB 90401 trial.Results: Eight sensory items formed a subscale with good internal consistency (Cronbach α = 0.88). Variables significantly associated with CisIPN included age at diagnosis (OR per year, 1.06; P = 2 × 10-9), smoking (OR, 1.54; P = 0.004), excess drinking (OR, 1.83; P = 0.007), and hypertension (OR, 1.61; P = 0.03). CisIPN was correlated with lower self-reported health (OR, 0.56; P = 2.6 × 10-9) and weight gain adjusted for years since treatment (OR per Δkg/m2, 1.05; P = 0.004). PrediXcan identified lower expressions of MIDN and RPRD1B, and higher THEM5 expression as associated with CisIPN (P value for each < 5 × 10-6) with replication of RPRD1B meeting significance criteria (Fisher combined P = 0.0089).Conclusions: CisIPN is associated with age, modifiable risk factors, and genetically determined expression level of RPRD1B Further study of implicated genes could elucidate the pathophysiologic underpinnings of CisIPN. Clin Cancer Res; 23(19); 5757-68. ©2017 AACR.
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Affiliation(s)
- M Eileen Dolan
- Department of Medicine, University of Chicago, Chicago, Illinois.
| | - Omar El Charif
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Heather E Wheeler
- Departments of Biology and Computer Science, Loyola University Chicago, Chicago, Illinois
| | - Eric R Gamazon
- Division of Genetic Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Patrick Monahan
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
| | - Darren R Feldman
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Robert J Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David J Vaughn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Jeri Kim
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sophie D Fossa
- Department of Oncology, Oslo University Hospital, Radiumhospital, Oslo, Norway
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan
| | | | - Michiaki Kubo
- RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | - Lawrence H Einhorn
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt University, Nashville, Tennessee
| | - Lois B Travis
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
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Visser NA, Notermans NC, de Vries JHM, van den Berg LH, Vrancken AFJE. The role of nutrition as risk factor for polyneuropathy: a case-control study. J Peripher Nerv Syst 2017; 22:455-459. [PMID: 28786512 DOI: 10.1111/jns.12233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
The aim of this case-control study is to investigate the role of nutrition as risk factor for polyneuropathy. Three hundred eighteen patients with chronic idiopathic axonal polyneuropathy and 636 matched controls completed a validated food frequency questionnaire that covered nutrient intake and alcohol consumption. As risk estimates, we calculated adjusted odds ratios for the intake of energy and nutrients. Energy and nutrient intake did not differ between patients and controls, regardless of moderate alcohol consumption. Nutrition is not a risk factor for chronic idiopathic axonal polyneuropathy.
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Affiliation(s)
- Nora A Visser
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanne H M de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Feltracco P, Cagnin A, Carollo C, Barbieri S, Ori C. Neurological disorders in liver transplant candidates: Pathophysiology and clinical assessment. Transplant Rev (Orlando) 2017; 31:193-206. [DOI: 10.1016/j.trre.2017.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/29/2016] [Accepted: 02/20/2017] [Indexed: 12/14/2022]
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Planas-Ballvé A, Grau-López L, Morillas RM, Planas R. Neurological manifestations of excessive alcohol consumption. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:709-717. [PMID: 28651796 DOI: 10.1016/j.gastrohep.2017.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 12/28/2022]
Abstract
This article reviews the different acute and chronic neurological manifestations of excessive alcohol consumption that affect the central or peripheral nervous system. Several mechanisms can be implicated depending on the disorder, ranging from nutritional factors, alcohol-related toxicity, metabolic changes and immune-mediated mechanisms. Recognition and early treatment of these manifestations is essential given their association with high morbidity and significantly increased mortality.
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Affiliation(s)
- Anna Planas-Ballvé
- Unidad de Neurociencias, Servicio de Neurología, Hospital Germans Trias i Pujol, Badalona (Barcelona), España.
| | - Laia Grau-López
- Unidad de Neurociencias, Servicio de Neurología, Hospital Germans Trias i Pujol, Badalona (Barcelona), España
| | - Rosa María Morillas
- Unidad de Hepatología, CIBERehd, Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona (Barcelona), España
| | - Ramón Planas
- Unidad de Hepatología, CIBERehd, Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona (Barcelona), España
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Hamel J, Logigian EL. Acute nutritional axonal neuropathy. Muscle Nerve 2017; 57:33-39. [PMID: 28556429 DOI: 10.1002/mus.25702] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This study describes clinical, laboratory, and electrodiagnostic features of a severe acute axonal polyneuropathy common to patients with acute nutritional deficiency in the setting of alcoholism, bariatric surgery (BS), or anorexia. METHODS Retrospective analysis of clinical, electrodiagnostic, and laboratory data of patients with acute axonal neuropathy. RESULTS Thirteen patients were identified with a severe, painful, sensory or sensorimotor axonal polyneuropathy that developed over 2-12 weeks with sensory ataxia, areflexia, variable muscle weakness, poor nutritional status, and weight loss, often with prolonged vomiting and normal cerebrospinal fluid protein. Vitamin B6 was low in half and thiamine was low in all patients when obtained before supplementation. Patients improved with weight gain and vitamin supplementation, with motor greater than sensory recovery. DISCUSSION We suggest that acute or subacute axonal neuropathy in patients with weight loss or vomiting associated with alcohol abuse, BS, or dietary deficiency is one syndrome, caused by micronutrient deficiencies. Muscle Nerve 57: 33-39, 2018.
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Affiliation(s)
- Johanna Hamel
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
| | - Eric L Logigian
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
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Langlois V, Bedat Millet AL, Lebesnerais M, Miranda S, Marguet F, Benhamou Y, Marcorelles P, Lévesque H. [Small fiber neuropathy]. Rev Med Interne 2017; 39:99-106. [PMID: 28410768 DOI: 10.1016/j.revmed.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/11/2017] [Indexed: 12/15/2022]
Abstract
Small fiber neuropathy (SFN) is still unknown. Characterised by neuropathic pain, it typically begins by burning feet, but could take many other expression. SFN affects the thinly myelinated Aδ and unmyelinated C-fibers, by an inherited or acquired mechanism, which could lead to paresthesia, thermoalgic disorder or autonomic dysfunction. Recent studies suggest the preponderant role of ion channels such as Nav1.7. Furthermore, erythromelalgia or burning mouth syndrome are now recognized as real SFN. Various aetiologies of SFN are described. It could be isolated or associated with diabetes, impaired glucose metabolism, vitamin deficiency, alcohol, auto-immune disease, sarcoidosis etc. Several mutations have recently been identified, like Nav1.7 channel leading to channelopathies. Diagnostic management is based primarily on clinical examination and demonstration of small fiber dysfunction. Laser evoked potentials, Sudoscan®, cutaneous biopsy are the main test, but had a difficult access. Treatment is based on multidisciplinary management, combining symptomatic treatment, psychological management and treatment of an associated etiology.
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Affiliation(s)
- V Langlois
- Service de médecine interne et maladies infectieuses, CH Le Havre, 29, avenue Pierre-Mendès, 76290 Montivilliers, France; U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France.
| | - A-L Bedat Millet
- Département de neurophysiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - M Lebesnerais
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - S Miranda
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - F Marguet
- Département d'anatomie et cytologie pathologiques, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - Y Benhamou
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
| | - P Marcorelles
- Département d'anatomie et cytologie pathologiques, hôpital Morvan, centre hospitalier régional et universitaire de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - H Lévesque
- U1096, service de médecine interne, Normandie univ, UNIROUEN, 76000 Rouen, France
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Dervaux A, Laqueille X. Le traitement par thiamine (vitamine B1) dans l’alcoolodépendance. Presse Med 2017; 46:165-171. [DOI: 10.1016/j.lpm.2016.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/15/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022] Open
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