Acute brachial plexus neuropathy as a presenting sign of peripheral nervous system involvement in paraproteinaemia

Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis)

BACKGROUND

Neuralgic amyotrophy (also know as Parsonage-Turner syndrome or brachial plexus neuritis) is a distinct peripheral nervous system disorder characterised by episodes (attacks) of extreme neuropathic pain and rapid multifocal weakness and atrophy in the upper limbs. Neuralgic amyotrophy has both an idiopathic and hereditary form, with similar clinical symptoms but generally an earlier age of onset and more episodes in the hereditary form. The current hypothesis is that the episodes are caused by an immune-mediated response to the brachial plexus. Recovery is slow, in months to years, and many patients are left with residual pain and decreased exercise tolerance of the affected limb(s). Anecdotal evidence suggests that corticosteroids may relieve pain or help improve functional recovery.

OBJECTIVES

The objective was to provide a systematic review of all randomised clinical trials of treatment in neuralgic amyotrophy.

SEARCH STRATEGY

We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2 2009), MEDLINE (January 1966 to April 2 2009), EMBASE (January 1980 to April 2 2009), CINAHL (January 1982 to April 2 2009), and LILACS (January 1982 to April 2 2009) for randomised controlled trials of treatment for neuralgic amyotrophy.

SELECTION CRITERIA

Any randomised or quasi-randomised trial of any intervention for neuralgic amyotrophy would be included in the review.

DATA COLLECTION AND ANALYSIS

Two review authors extracted the data (RH, NvA) and two authors assessed study quality and performed data extraction independently (NvA, BvE).

MAIN RESULTS

No randomised or quasi-randomised trials were identified. In 30 articles anecdotal evidence was found on treatment for neuralgic amyotrophy. Only three of these articles contained more than 10 treated cases, with one providing sufficient details to calculate the primary and secondary outcome measures for this review.

AUTHORS' CONCLUSIONS

At this moment there is no evidence from randomised trials on any form of treatment for neuralgic amyotrophy. Evidence from one open-label retrospective series suggests that oral prednisone given in the first month after onset can shorten the duration of the initial pain and leads to earlier recovery in some patients. Randomised clinical trials are needed to establish the efficacy of treatment with corticosteroids or other immune-modulating therapies.