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Gondim FDAA, Barreira AA, Claudino R, Cruz MW, Cunha FMBD, Freitas MRGD, França MC, Gonçalves MVM, Marques W, Nascimento OJM, Oliveira ASB, Pereira RC, Pupe C, Rotta FT, Schestatsky P. Definition and diagnosis of small fiber neuropathy: consensus from the Peripheral Neuropathy Scientific Department of the Brazilian Academy of Neurology. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:200-208. [PMID: 29809227 DOI: 10.1590/0004-282x20180015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/15/2018] [Indexed: 01/20/2023]
Abstract
The aim of this study was to describe the results of a Brazilian Consensus on Small Fiber Neuropathy (SFN). Fifteen neurologists (members of the Brazilian Academy of Neurology) reviewed a preliminary draft. Eleven panelists got together in the city of Fortaleza to discuss and finish the text for the manuscript submission. Small fiber neuropathy can be defined as a subtype of neuropathy characterized by selective involvement of unmyelinated or thinly myelinated sensory fibers. Its clinical picture includes both negative and positive manifestations: sensory (pain/dysesthesias/pruritus) or combined sensory and autonomic complaints, associated with an almost entirely normal neurological examination. Standard electromyography is normal. A growing list of medical conditions is associated with SFN. The classification of SFN may also serve as a useful terminology to uncover minor discrepancies in the normal values from different neurophysiology laboratories. Several techniques may disclose sensory and/or autonomic impairment. Further studies are necessary to refine these techniques and develop specific therapies.
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Affiliation(s)
| | - Amilton Antunes Barreira
- Departamento de Neurociências e Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Rinaldo Claudino
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Márcia Waddington Cruz
- Departamento de Neurologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Wilson Marques
- Departamento de Neurociências e Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | | | - Camila Pupe
- Departamento de Neurologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brasil
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Unusual Concurrence of HTLV-I Infection and Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Plasma Cell Disorder, and Skin Changes Syndrome. J Clin Neuromuscul Dis 2017; 18:163-164. [PMID: 28221311 DOI: 10.1097/cnd.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Espíndola OM, Vizzoni AG, Lampe E, Andrada-Serpa MJ, Araújo AQC, Leite ACC. Hepatitis C virus and human T-cell lymphotropic virus type 1 co-infection: impact on liver disease, virological markers, and neurological outcomes. Int J Infect Dis 2017; 57:116-122. [PMID: 28185943 DOI: 10.1016/j.ijid.2017.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Human T-cell lymphotropic virus type 1 (HTLV-1) infection is associated with neurological abnormalities, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and peripheral neuropathy (PN). Hepatitis C virus (HCV) infection is the leading cause of chronic liver disease worldwide, and causes PN in approximately 9% of patients. Because the interplay between these potentially neuropathogenic viruses in the same individual is still poorly understood, the clinical and laboratory outcomes of co-infected patients were evaluated and compared with those of controls. METHODS The prevalence rates of neurological and laboratory abnormalities were evaluated in HCV/HTLV-1 co-infected patients (n=50), and in subjects with single HCV (n=46) or HTLV-1 (n=150) infection. RESULTS A higher frequency of isolated PN was present in HCV-infected patients; this was not associated with cryoglobulinemia. No difference was found in the frequency of PN or HAM/TSP when co-infected subjects were compared to singly infected subjects. Hepatic involvement was present in HCV-infected subjects, as shown by increased levels of serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and bilirubin, in addition to thrombocytopenia. On the other hand, HCV/HTLV-1 co-infected individuals presented a better prognosis for hepatic involvement when compared with singly HCV-infected subjects. CONCLUSIONS These data suggest that HCV/HTLV-1 co-infection does not mutualistically alter the outcome with regard to neurological manifestations. Nonetheless, changes in the immunological environment induced by HTLV-1 infection could lead to a reduction in hepatic damage, even without significant HCV clearance.
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Affiliation(s)
- Otávio M Espíndola
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Alexandre G Vizzoni
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Elisabeth Lampe
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute (IOC) - FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria José Andrada-Serpa
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Abelardo Q C Araújo
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Ana Claudia C Leite
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil.
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Abstract
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents.
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Affiliation(s)
- Kate T. Brizzi
- Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Lyons
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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