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Moretti R, Caruso P, Dal Ben M, Gazzin S, Tiribelli C. Hepatitis C-related cryoglobulinemic neuropathy: potential role of oxcarbazepine for pain control. BMC Gastroenterol 2018; 18:19. [PMID: 29370761 PMCID: PMC5785793 DOI: 10.1186/s12876-018-0751-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/21/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Peripheral neuropathy is one most common, limiting and invalidating neurological symptom in subjects with hepatitis C virus and mixed cryoglobulinemia. Notably, the medical therapy proposed to eradicate HCV, can frequently exacerbate the painful neuropathy. Therefore, neuropathy therapies are insufficient and inadequate, and comprise immunosuppressive drugs, such as steroid or cyclosporine, intravenous immunoglobulin or plasma exchange. These have shown variable success in case reports, with a presumably temporary effect, but with major side effects. METHODS We assessed the effects of oxcarbazepine treatment in 67 cases of cryoglobulinemia related neuropathy, who did not respond to either steroid or Gabapentin, or Pregabalin. Oxcarbazepine was chosen based on the promising preliminary results. RESULTS Patients treated with Oxcarbazepine showed a rapid, discrete and persistent relief of polyneuropathic signs, without consistent side effects, and with a limited interaction with concomitant drugs. CONCLUSIONS These data favor the use of oxcarbazepine as a useful tool in the management of neuropathic pain associated with Hepatitis-C cryoglobulin neuropathy.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34100, Trieste, Italy
| | - Paola Caruso
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34100, Trieste, Italy
| | - Matteo Dal Ben
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34100, Trieste, Italy.,Italian Liver Foundation, Centro Studi Fegato, AREA Science Park, Bldg. Q, Ss 14, km 163.5, 34149, Trieste, Italy
| | - Silvia Gazzin
- Italian Liver Foundation, Centro Studi Fegato, AREA Science Park, Bldg. Q, Ss 14, km 163.5, 34149, Trieste, Italy.
| | - Claudio Tiribelli
- Italian Liver Foundation, Centro Studi Fegato, AREA Science Park, Bldg. Q, Ss 14, km 163.5, 34149, Trieste, Italy
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Sellner J, Steiner I. Neurologic complications of hepatic viruses. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:647-61. [PMID: 25015509 DOI: 10.1016/b978-0-444-53488-0.00031-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität Munich, Germany
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Hepatitis C virus (HCV) infection is a growing international health problem, and more than 170 million people are chronic carriers. Up to 50% of HCV-positive patients develop at least one extrahepatic manifestation during the course of disease. To varying degrees of certainty, there is evidence of an association between chronic HCV infection and a variety of neuromuscular diseases. The pathogenesis of most extrahepatic diseases remains unclear but possibly includes HCV lymphotropism and/or HCV-induced autoantibodies. The therapeutic approach to HCV-associated autoimmune disorders entails eradication of HCV with one of the recombinant interferon-alpha preparations with or without additional immunosuppressive drugs.
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Prevalence and risk factors associated with the presence of peripheral neuropathy in patients with hepatitis C virus infection. J Clin Neuromuscul Dis 2012; 4:109-14. [PMID: 19078700 DOI: 10.1097/00131402-200303000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To determine the frequency and risk factors associated with peripheral neuropathy in a population of patients with hepatitis C virus infection. METHODS Cross-sectional study. Electrophysiological assessment included bilateral motor and sensory conduction studies of four limbs. RESULTS Thirty-one cases and 31 control subjects were studied. Eighteen patients (58%) from the group of patients infected with the hepatitis C virus had evidence of neuropathy. Only 3 (10%) persons from the control group exhibited neuropathy. Among the risk factors for neuropathy in the patients infected with hepatitis C virus, we found the following: positive rheumatoid factor, cryoglobulinemia, and cirrhosis or active hepatitis. Other risk factors were advanced age, prolonged time of evolution, high viral load of the hepatitis C virus, and low complement. CONCLUSIONS The frequency of neuropathy encountered in our study was high (58%). In our study, a positive rheumatoid factor, cryoglobulins, and a high viral load were also associated with the presence of peripheral neuropathy. A high viral load could express possible direct viral damage.
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Stübgen JP. Immune-mediated myelitis associated with hepatitis virus infections. J Neuroimmunol 2011; 239:21-7. [PMID: 21945641 DOI: 10.1016/j.jneuroim.2011.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/24/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
Virus-induced spinal cord damage results from a cytolytic effect on anterior horn cells or from predominantly cellular immune-mediated damage of long white matter tracts. Infection with the hepatitis virus group, most notably hepatitis C virus, has infrequently been associated with the occurrence of myelitis. The pathogenesis of hepatitis virus-associated myelitis has not been clarified: virus-induced autoimmunity (humoral or cell-mediated, possibly vasculitic) seems the most likely disease mechanism. Limited available information offers no evidence of direct hepatitis virus infection of the spinal cord. Virus neuropenetration may occur after virus-infected mononuclear cells penetrate the blood-brain barrier, but a true neurolytic effect has not been demonstrated. Attacks of acute myelitis usually respond favorably to immunomodulatory therapy. Antiviral therapy plays no confirmed role in the treatment of acute bouts of myelitis, but may limit the relapsing course of HCV-associated myelitis.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology and Neuroscience, Cornell University Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
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Acute wrist and foot drop associated with hepatitis C virus related mixed cryoglobulinemia: Rapid response to treatment with rituximab. J Clin Virol 2010; 47:69-71. [DOI: 10.1016/j.jcv.2009.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 09/29/2009] [Accepted: 10/06/2009] [Indexed: 01/04/2023]
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Abstract
PURPOSE OF REVIEW Infectious neuropathy affects a large number of people worldwide. There is evidence of direct involvement of nerves by the infective agent, from the immune reaction of the patient or secondary to the toxicity of the drugs used during treatment. This group of neuropathies is often treatable or preventable. RECENT FINDINGS There is a complex clinical picture of the neuropathy of leprosy, different pathological features and immunological mechanisms. If the skin is unaffected in leprosy it is not always easy to demonstrate that the neuropathy is due to leprosy. Peripheral neuropathy in patients with chronic infection with hepatitis C virus may be due to the virus, the development of vasculitis or direct neurotoxic effects of the treatment. Peripheral neuropathy has become the chief neurological syndrome in individuals infected with HIV-1. The antiretroviral therapies themselves can cause peripheral neuropathies clinically indistinguishable from those caused by the virus. The occurrence of chronic polyneuropathy as a late manifestation in Lyme disease is extremely rare and is not well understood. SUMMARY Although infectious neuropathies are very frequent, mainly in developing countries, further studies are needed to elucidate their mechanisms of action, focusing on preventive interventions.
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Rafai MA, Gam I, Fadel H, Hakim K, El Moutawakkil B, Bendahmane A, Kissani N, Alaoui R, Cherkaoui A, Slassi I. Neuropathies périphériques sans cryoglobulinémie révélatrices de l’hépatite virale C. Rev Neurol (Paris) 2006; 162:623-7. [PMID: 16710128 DOI: 10.1016/s0035-3787(06)75056-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Peripheral neuropathies are the most common neurological complication of viral hepatitis C infection with mixed cryoglobulinemia. CASES REPORT We report five cases (three men, two women) of peripheral neuropathies revealing viral hepatitis C infection without cryoglobulinemia; the patients' mean age was 56 years. Paresthesias were the most frequent symptom. Electroneuromyographic examination found one case of polyneuropathy and four cases of multiplex mononeuropathies; the complement level was normal in all patients and the rheumatoid factor positive in two cases. Etiological investigations for peripheral neuropathy remained negative. Treatment and outcome were variable. DISCUSSION Negative cryoglobulinemia in cases of VHC infection with neurological features has been described in the last few years, suggesting the possibility of other mechanisms such as direct action of the virus on the nervous system. There is no consensus on the treatment and outcome is variable. CONCLUSION Peripheral neuropathy may reveal VHC infection, underscoring the need for VHC serology testing in etiological investigations for peripheral neuropathies.
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Affiliation(s)
- M A Rafai
- Service de Neurologie - Explorations fonctionnelles, CHU ibn Rochd, quartier des hôpitaux, Casablanca, Maroc.
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Cacoub P, Saadoun D, Limal N, Léger JM, Maisonobe T. Hepatitis C virus infection and mixed cryoglobulinaemia vasculitis: a review of neurological complications. AIDS 2005; 19 Suppl 3:S128-34. [PMID: 16251808 DOI: 10.1097/01.aids.0000192081.33938.2f] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic liver disease caused by hepatitis C virus (HCV) infection is commonly associated with extrahepatic manifestations, mainly mixed cryoglobulinaemia. Neurological complications in HCV-infected patients occur predominantly in the peripheral nervous system. Peripheral neuropathy in HCV infection is primarily associated with mixed cryoglobulinaemia. Central nervous system (CNS) involvement is more rarely reported. In this review, peripheral and CNS involvement associated with chronic HCV infection are described. The underlying mechanisms and treatment possibilities are discussed.
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Affiliation(s)
- Patrice Cacoub
- Department of Internal Medicine, Hôpital La Pitié-Salpêtrière, Paris, France.
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Guilpain P, Servettaz A, Tamby MC, Chanseaud Y, Le Guern V, Guillevin L, Mouthon L. Pathogénie des vascularites systémiques primitives (II): vascularites ANCA-négatives. Presse Med 2005; 34:1023-33. [PMID: 16225258 DOI: 10.1016/s0755-4982(05)84105-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The pathogenesis of different types of systemic vasculitis negative for antineutrophil cytoplasm antibodies (ANCA) and involving small or medium-sized vessels is not very well documented. During polyarteritis nodosa (PAN), which is related to hepatitis B virus (HBV) infection, as well as during cryoglobulinemic vasculitides, associated with hepatitis C virus (HCV), and probably during Henoch Schönlein purpura, histological lesions may result from the deposition of immune complexes formed from viral antigens and from antibodies responsible for the activation of the classic complement pathway and for recruitment of polymorphonuclear neutrophils. Two other mechanisms are discussed for other types of ANCA-negative systemic vasculitis: immune complex deposition and sheer stress at arterial bifurcation points. A bacterial superantigen is suspected in Kawasaki disease but remains unproved.
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Affiliation(s)
- P Guilpain
- Université Paris-Descartes, Faculté de médecine, UPRES EA 1833, site Cochin, Paris
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Said G, Lacroix C. Primary and secondary vasculitic neuropathy. J Neurol 2005; 252:633-41. [PMID: 15806339 DOI: 10.1007/s00415-005-0833-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 02/04/2005] [Indexed: 01/24/2023]
Abstract
Necrotizing vasculitis occurs as a primary phenomenon in connective tissue disorders and cognate fields, including polyarteritis nodosa and the Churg and Strauss syndrome variant, rheumatoid arthritis, systemic lupus and Wegener's granulomatosis. In all these conditions focal and multifocal neuropathy occur as a consequence of destruction of the arterial wall and occlusion of the lumen of small epineurial arteries. Vasculitis may also complicate the course of other conditions ranging from infection with the HIV and with the B and C hepatitis viruses to diabetes and sarcoidosis. Pathologically polymorphonuclear cells are present in the infiltrates of the vessel wall in primary necrotizing vasculitis, while in secondary vasculitis the inflammatory infiltrate is mainly composed of mononuclear cells. In all instances symptomatic vasculitis requires corticosteroid to control the inflammatory process and prevent further ischemic nerve lesions.
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Affiliation(s)
- Gérard Said
- Service de Neurologie, Hôpital de Bicêtre (Université Paris XI), 94275, Le Kremlin Bicêtre, France.
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Peffault de Latour R, Lévy V, Asselah T, Marcellin P, Scieux C, Adès L, Traineau R, Devergie A, Ribaud P, Espérou H, Gluckman E, Valla D, Socié G. Long-term outcome of hepatitis C infection after bone marrow transplantation. Blood 2003; 103:1618-24. [PMID: 14576071 DOI: 10.1182/blood-2003-06-2145] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic hepatitis C is often asymptomatic, at least during the first decade following hematopoietic stem cell transplantation. Progression to advanced liver disease or cirrhosis in patients surviving more than 10 years is currently thought to be rare. Among 1078 patients who underwent an allogeneic transplantation between January 1973 and January 1995, 96 patients infected by hepatitis C virus (HCV) during the transplantation period were studied. Cumulative incidence and analysis of risk factors for cirrhosis were analyzed, and the rate and risk of cirrhosis in transplant recipients were compared with those of 158 HCV-infected controls who did not receive transplants. At a median follow-up of 15.7 years, 15 patients developed biopsy-proven cirrhosis, leading to a cumulative incidence of cirrhosis of 11% and 24% at 15 and 20 years, respectively. By multivariate analysis, extrahepatic HCV manifestations and HCV genotype 3 were associated with risk of cirrhosis. The median time to cirrhosis in transplant recipients was 18 years as compared with 40 years in the control population. The risk of cirrhosis in transplant recipients relative to controls was significantly higher by multivariate analysis (P =.0008). Roughly a quarter of long-term HCV-infected survivors with transplants progressed to cirrhosis that is much more rapid than in patients without transplants. Systematic detection of HCV infection, liver biopsy, and therapeutic intervention are therefore warranted in long-term marrow transplant recipients.
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Abstract
The treatment for chronic hepatitis C with interferon and ribavirin is associated with a large number of untoward side effects ( Cornberg, Wedemeyer &, Manns, 2002). Management of these adverse effects has a great impact on the compliance of affected patients during the course of their treatment. Thus, the influence of the nurse on patient compliance and quality of life improvement during interferon and ribavirin treatment cannot be understated. Anecdotally, from the patient's point of view, the adverse effects of treatment often overshadow the goal of treatment, viral clearance. Nurses, as a result of their role as patient advocates, have the ability to enhance treatment compliance greatly by recognizing and managing treatment-associated side effects.
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Affiliation(s)
- Nancy E Leone
- Loyola University Medical Center, 2160 South First Avenue, Building 114, Rm 48, Maywood, IL 60153, USA.
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