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Mustafa B, Yousaf Q, Aslam A, Farooq M, Ashraf A, Ehsan M, Zahid A, Athar F. Rarest of the rare: a case of pharyngeal-cervical-brachial variant of Guillain-Barré syndrome presenting with a demyelinating neuropathy. Int J Neurosci 2024; 134:53-55. [PMID: 35658783 DOI: 10.1080/00207454.2022.2084090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a heterogeneous disease characterized by rapidly progressive, symmetrical limb weakness with hyporeflexia or areflexia. The rare pharyngeal-cervical-brachial (PCB) variant of GBS occurs in 3% of patients, presenting as rapidly progressive oropharyngeal and cervicobrachial weakness characterised by axonal, rather than a demyelinating neuropathy on nerve conduction studies. CASE DESCRIPTION A 35 year old male presented with a 5-day history of dysphagia, dysarthria, slurred speech and upper limb weakness. Physical examination showed bilateral facial nerve weakness and an impaired gag reflex. Nerve conduction study was suggestive of sensory and motor polyneuropathy of predominantly demyelinating variety. As the condition of the patient worsened, respiratory support was required and plasmapharesis was started. There was significant improvement in his condition after completion of 5 sessions of plasmapharesis. CONCLUSION The rare PCB variant may present with a predominantly demyelinating neuropathy. Early clinical recognition of this variant and prompt treatment with plasmapharesis is essential for preventing respiratory complications.
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Affiliation(s)
- Biah Mustafa
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Qudsum Yousaf
- Department of Neurology, Central Park Teaching Hospital, Lahore, Pakistan
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Minaam Farooq
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Arfa Ashraf
- Department of Neurology, CMH LMC & IOD, Lahore, Pakistan
| | - Muhammad Ehsan
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Afra Zahid
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Farwa Athar
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
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Davis TME, Chubb SAP, Peters KE, Davis WA. Serum vitamin B12, distal symmetrical polyneuropathy and anaemia in type 2 diabetes: the Fremantle Diabetes Study Phase 2. Intern Med J 2024; 54:575-581. [PMID: 37665691 DOI: 10.1111/imj.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND There are limited data relating to the effects of metformin-associated vitamin B12 deficiency on the risk of distal symmetrical polyneuropathy (DSPN) and megaloblastic anaemia in well-characterised community-based cohorts. AIMS To assess inter-relationships between metformin therapy, vitamin B12 deficiency assessed using serum active B12 concentrations, and DSPN and anaemia in 1492 Fremantle Diabetes Study Phase 2 (FDS2) participants with type 2 diabetes. METHODS Prevalence rates of vitamin B12 deficiency (total <80 pmol/L, active <23 pmol/L) and borderline deficiency (total ≥80 and ≤200 pmol/L, active ≥23 and ≤35 pmol/L) were determined using baseline sera. The relationship between vitamin B12 status and both DSPN and anaemia was assessed using multivariable analyses. RESULTS Most FDS2 participants (94.4%) were vitamin B12 replete (total serum concentration >200 pmol/L, active >35 pmol/L), 2.0% were deficient (total <80 pmol/L, active <23 pmol/L) and the remainder (3.6%) borderline. Although metformin treatment increased the odds of deficiency (4.2%, 3.1% borderline) in a dose-dependent fashion (odds ratio (95% confidence interval) 39.4 (4.90-316) for >2000 mg daily compared with no treatment; P < 0.001), there was no significant association between vitamin B12 status and DSPN, anaemia (haemoglobin ≤130 g/L males, ≤120 g/L females), haemoglobin concentration or mean corpuscular volume (P ≥ 0.147). Metformin increased the likelihood of anaemia, especially at high doses, independent of vitamin B12 deficiency. CONCLUSIONS Since nutritional sources likely attenuate metformin-associated vitamin B12 malabsorption and its clinical sequelae in developed countries such as Australia, there is no need for routine/opportunistic serum vitamin B12 screening in metformin-treated patients.
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Affiliation(s)
- Timothy M E Davis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen A P Chubb
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kirsten E Peters
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Proteomics International, QEII Medical Centre, Perth, Western Australia, Australia
| | - Wendy A Davis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
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Lai Y, Chiu W, Huang C, Cheng B, Yu I, Kung C, Lin TY, Chiang HC, Kuo CA, Lu C. Prognostic value of longitudinal HbA1c variability in predicting the development of diabetic sensorimotor polyneuropathy among patients with type 2 diabetes mellitus: A prospective cohort observational study. J Diabetes Investig 2024; 15:326-335. [PMID: 38168098 PMCID: PMC10906024 DOI: 10.1111/jdi.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
AIMS/INTRODUCTION This prospective cohort study aims to identify the optimal measure of glycated hemoglobin (HbA1c) variability and to explore its relationship with the development of new diabetic sensorimotor polyneuropathy (DSPN) in individuals with type 2 diabetes mellitus, building upon previous cross-sectional studies that highlighted a significant association between HbA1c visit-to-visit variability and DSPN. MATERIALS AND METHODS In a prospective study, 321 participants diagnosed with type 2 diabetes mellitus underwent comprehensive clinical assessments, neurophysiologic studies, and laboratory evaluations at enrollment and follow-up. Various indices, including HbA1c standard deviation (HbA1c SD), coefficient of variation (HbA1c CV), HbA1c change score (HbA1c HVS), and average real variability (HbA1c ARV), were employed to calculate the visit-to-visit variability HbA1c based on 3 month intervals. The investigation focused on examining the associations between these indices and the development of new DSPN. RESULTS The average follow-up duration was 16.9 ± 6.9 months. The Cox proportional hazards model identified age (P = 0.001), diabetes duration (P = 0.024), and HbA1C ARV (P = 0.031) as the sole factors associated with the development of new DSPN. Furthermore, the cumulative risk of developing DSPN over 1 year demonstrated a significant association with HbA1C ARV (P = 0.03, log-rank test). CONCLUSIONS Apart from age and diabetes duration, HbA1c variability emerged as a robust predictor for the occurrence of new DSPN. Among the various measures of HbA1c variability evaluated, HbA1c ARV demonstrated the highest potential as a reliable indicator for anticipating the onset of new DSPN.
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Affiliation(s)
- Yun‐Ru Lai
- Department of NeurologyKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
- Department of Hyperbaric Oxygen Therapy CenterKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Wen‐Chan Chiu
- Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chih‐Cheng Huang
- Department of NeurologyKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Ben‐Chung Cheng
- Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - I‐Hsun Yu
- Department of NeurologyKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chia‐Te Kung
- Department of Emergency MedicineKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Ting Yin Lin
- Department of NursingKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Hui Ching Chiang
- Department of NeurologyKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chun‐En Aurea Kuo
- Department of Chinese MedicineKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
| | - Cheng‐Hsien Lu
- Department of NeurologyKaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
- Department of Biological ScienceNational Sun Yat‐Sen UniversityKaohsiungTaiwan
- Department of NeurologyXiamen Chang Gung Memorial HospitalXiamenFujianChina
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Pierce J, Han K, Vinters HV, Zuckerman JE, Halabi A. Severe Polyneuropathy in Hereditary Transthyretin Amyloidosis Caused by H90D Variant. Can J Neurol Sci 2024; 51:336-338. [PMID: 36624082 DOI: 10.1017/cjn.2023.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Joshua Pierce
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Karam Han
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Harry V Vinters
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Jonathan E Zuckerman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Anasheh Halabi
- Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Davis WA, Hamilton E, Davis TME. Temporal Trends in Distal Symmetric Polyneuropathy in Type 2 Diabetes: The Fremantle Diabetes Study. J Clin Endocrinol Metab 2024; 109:e1083-e1094. [PMID: 37930807 PMCID: PMC10876392 DOI: 10.1210/clinem/dgad646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT Macrovascular outcomes in type 2 diabetes have improved over recent decades. There are scant equivalent distal symmetric polyneuropathy (DSPN) data. OBJECTIVE This work aimed to characterize temporal changes in DSPN prevalence and incidence rates (IRs) in community-based Australians. METHODS An observational study was conducted among an urban population. Participants included individuals with type 2 diabetes from the Fremantle Diabetes Study phases I (FDS1; n = 1296 recruited 1993-1996) and II (FDS2; n = 1509 recruited 2008-2011). Main outcome measures included Michigan Neuropathy Screening Instrument (MNSI) clinical grading. RESULTS DSPN prevalence by 8-point MNSI was 30.8% (FDS1) and 58.9% (FDS2; P < .001), and by 6-point (excluding foot appearance) and 2-point (biothesiometry alone) MNSI was 37.5% and 35.7% (P = .336), and 33.8% and 38.7% (P = .011), respectively. Given between-phase changes in appearance assessment, 8-point MNSI data were not analyzed further. In multivariable analysis, FDS2 vs FDS1 participation was associated with 6-point (odds ratio (95% CI) 0.68 (0.56-0.83); P < .001) but not 2-point (0.90 (0.74-1.11); P = .326) MNSI DSPN prevalence. Four-year DSPN IRs (95% CI) for 6-point MNSI were 13.6 (12.0-15.4) and 17.6 (15.9-19.4)/100 person-years in FDS1 and FDS2, respectively (IR ratio [IRR] 1.31 [1.12-1.55]; P < .001), and for 2-point MNSI were 13.9 (12.3-15.8) and 7.4 (16.3-8.6/100 person-years; IRR 0.53 [0.43-0.64]; P < .001). FDS2 vs FDS1 independently predicted incident DSPN for 6-point (hazard ratio [95% CI] 1.25 [1.06-1.48]; P = .009) and 2-point (0.42 [0.33-0.55]; P < .001) MNSI. CONCLUSION DSPN prevalence was lower or equivalent in FDS2 vs FDS1, and its incidence was greater or lower, in multivariable models depending on the MNSI features used.
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Affiliation(s)
- Wendy A Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, WA 6959, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Emma Hamilton
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, WA 6959, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals Group, Murdoch, WA 6150, Australia
| | - Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, WA 6959, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals Group, Murdoch, WA 6150, Australia
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Meyer-Marcotty MV, Attabit A, März V, Vogt PM. Nerve Decompression in the Lower Leg Results in an Improvement in Symptoms in Patients With Both Diabetic and Idiopathic Polyneuropathy. Ann Plast Surg 2024; 92:212-221. [PMID: 38170967 DOI: 10.1097/sap.0000000000003727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Patients suffering from polyneuropathy often complain of pain, tingling, and numbness sensations, as well as an increased risk of falling with the corresponding subsequent complications. If symptoms persist after conservative treatment options have been exhausted, nerve decompression in the lower extremity, as described by Dellon, can bring about an improvement in symptoms in many patients. Dellon originally reported that this surgery led to very successful outcomes in patients with diabetic polyneuropathy. In this study, we compare our postsurgical results in patients with diabetic versus idiopathic polyneuropathy. METHODS Thirty-three patients with idiopathic or diabetic polyneuropathy who had undergone Dellon nerve decompression in the lower extremity between 2011 and 2013 were included in the retrospective study. Pain (numeric rating scale [NRS] 0-10; 0, no pain; 10, worst imaginable pain), tingling, numbness, Hoffmann-Tinel sign, and Semes-Weinstein monofilament were assessed in 20 patients with diabetic polyneuropathy and in 13 patients with idiopathic polyneuropathy. RESULTS Three months after surgery, a significant reduction in pain was evident in patients with diabetic polyneuropathy, from a preoperative level of NRS 4.9 (minimum, 0; maximum, 10) to 2 (minimum, 0; maximum, 8; P = 0.005). Ninety percent of patients complained of tingling ( P = 0.000) before surgery and 18% after surgery, whereas 100% complained of numbness before surgery and 41% ( P = 0.000) after surgery. One hundred percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 24% of patients still had no measurable surface sensitivity ( P = 0.000). A positive Hoffmann-Tinel sign was recorded in 85% of patients before surgery and only in 11% 3 months after surgery ( P = 0.000). In the case of patients with idiopathic polyneuropathy, a reduction in pain was evident 3 months after surgery, from a preoperative level of NRS 3.9 (minimum, 0; maximum, 9) to 2.2 (minimum, 0; maximum, 9; P = 0.058). Seventy-seven percent of patients complained of tingling before surgery and 42% after surgery ( P = 0.111), whereas 92% complained of numbness before surgery and 50% after surgery ( P = 0.030). Seventy-seven percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 33% of patients still had no measurable surface sensitivity ( P = 0.047). A positive Hoffmann-Tinel sign was recorded in 62% of patients before surgery and only in 17% 3 months after surgery ( P = 0.041). CONCLUSIONS Not only patients with diabetic polyneuropathy but also those with idiopathic polyneuropathy benefit from Dellon nerve decompression surgery in the lower extremities.
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Affiliation(s)
- Max V Meyer-Marcotty
- From the Department of Plastic Surgery and Hand Surgery, Lüdenscheid Hospital, Lüdenscheid
| | - Abduasalam Attabit
- From the Department of Plastic Surgery and Hand Surgery, Lüdenscheid Hospital, Lüdenscheid
| | - Vincent März
- Department of Plastic Surgery and Hand Surgery, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic Surgery and Hand Surgery, Hannover Medical School, Hannover, Germany
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Hassing LT, Jiang FY, Zutt R, Arends S. Nitrous-oxide-induced polyneuropathy and subacute combined degeneration of the spine: clinical and diagnostic characteristics in 70 patients, with focus on electrodiagnostic studies. Eur J Neurol 2024; 31:e16076. [PMID: 37754673 DOI: 10.1111/ene.16076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Nitrous oxide (N2 O) induced neurological symptoms are increasingly encountered. Our aim is to provide clinical and diagnostic characteristics with a focus on electrodiagnostic studies. METHODS Patients with neurological sequelae due to N2 O presenting in our hospital between November 2018 and December 2021 reporting clinical and diagnostic data were retrospectively reviewed. RESULTS Seventy patients (median 22 years) were included. Median N2 O usage was 4 kg/week during 12 months. Patients' history revealed a higher rate of sensory symptoms compared to motor (97% vs. 57%) and 77% walking difficulties. Clinical diagnosis was polyneuropathy (PNP) in 44%, subacute combined degeneration (SCD) of the spine in 19%, both in 37%. Median vitamin B12 level was low (159 pmol/L), normal in 16%. The median methylmalonic acid was increased (2.66 μmol/L). Electrodiagnostic abnormalities were observed in 91%, with 72% fulfilling axonal PNP criteria, 20% showing mild to intermediate slowing. One patient fulfilled demyelinating PNP criteria not related to N2 O abuse (Charcot-Marie-Tooth type 1a). More prominent motor nerve conduction abnormalities were found; lower limbs were more affected. In 64% with normal conduction, myography showed signs of axonal loss. Magnetic resonance imaging showed cervical myelopathy in 58% involving generally five to six segments. CONCLUSIONS Nitrous oxide (N2 O) leads to neurological symptoms by causing PNP and/or SCD primarily involving the legs. Distinguishing PNP and SCD clinically was shown to be insufficient. Electrodiagnostic studies showed axonal PNP. Demyelinating PNP due to N2 O abuse was not present in our cohort. Therefore, further diagnostic work-up is warranted if demyelinating features are present.
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Affiliation(s)
- L T Hassing
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
| | - F Y Jiang
- HagaZiekenhuis, Department of Radiology, The Hague, The Netherlands
| | - R Zutt
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
| | - S Arends
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
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Huang LY, Peng YJ, Sung YF. Anti-SRP Myopathy with Sensorimotor Polyneuropathy: A Case Report. Acta Neurol Taiwan 2023; 32(4):212-217. [PMID: 37723914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Anti-signal recognition particle (SRP) myopathy is a subtype of immune-mediated necrotizing myopathy. It rarely presents with extramuscular features, involving the skin, lung, and heart. This paper presents a case of anti-SRP myopathy associated with sensorimotor polyneuropathy. CASE REPORT A 33-year-old woman with no history of systemic disease presented to our hospital with weakness and numbness of the lower limbs for 1 year. Electromyography and nerve conduction study (NCS) revealed combined myopathy and axonal sensorimotor polyneuropathy. Blood examination revealed increased levels of serum muscle enzymes and anti-SRP antibodies. T1-weighted magnetic resonance imaging revealed diffuse muscular hyperintensities in the thighs, indicative of fatty replacement. She was administered methylprednisolone pulse therapy, followed by oral prednisolone and azathioprine. Muscle power increased, and serum muscle enzyme levels decreased significantly. Subsequent NCS performed 2 years later revealed persistent axonal degeneration in the lower limbs. CONCLUSION Anti-SRP myopathy can present with sensorimotor polyneuropathy. Thus, the possibility that the same pathological process affected the skeletal muscles and peripheral nerves should be considered.
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Affiliation(s)
- Lei-Ying Huang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ragavendar B, Sugumaran R, Narayan SK, Srinivas BH. Chronic inflammatory axonal polyneuropathy with myositis: a rare presentation. Acta Neurol Belg 2023; 123:2423-2426. [PMID: 37010789 DOI: 10.1007/s13760-023-02256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023]
Affiliation(s)
- B Ragavendar
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantri Nagar, Pondicherry, 605006, India
| | - Ramkumar Sugumaran
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantri Nagar, Pondicherry, 605006, India.
| | - Sunil K Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantri Nagar, Pondicherry, 605006, India
| | - B H Srinivas
- Department of Pathology, JIPMER, Pondicherry, India
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Theis M, Donath H, Woelke S, Bakhtiar S, Salzmann-Manrique E, Zielen S, Kieslich M. Peripheral polyneuropathy in children and young adults with ataxia-telangiectasia. Eur J Neurol 2023; 30:3842-3853. [PMID: 37540892 DOI: 10.1111/ene.16028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE Ataxia-telangiectasia (A-T) is a rare, autosomal recessive, multisystem disorder that leads to progressive neurodegeneration with cerebellar ataxia and peripheral polyneuropathy. Cerebellar neurodegeneration is well described in A-T. However, peripheral nervous system involvement is an underdiagnosed but important additional target for supportive and systemic therapies. The aim of this study was to conduct neurophysiological measurements to assess peripheral neurodegeneration and the development of age-dependent neuropathy in A-T. METHODS In this prospective study, 42 classical A-T patients were assessed. The motor and sensory nerve conduction of the median and tibial nerves was evaluated. Data were compared to published standard values and a healthy age- and gender-matched control group of 23 participants. Ataxia scores (Klockgether, Scale for the Assessment and Rating of Ataxia) were also assessed. RESULTS In A-T, neurophysiological assessment revealed neuropathic changes as early as the first year of life. Subjective symptomatology of neuropathy is rarely described. In the upper extremities, motor neuropathy was predominantly that of a demyelinating type and sensory neuropathy was predominantly that of a mixed type. In the lower extremities, motor and sensory neuropathy was predominantly that of a mixed type. We found significant correlations between age and the development of motor and sensory polyneuropathy in A-T compared with healthy controls (p < 0.001). CONCLUSIONS In A-T, polyneuropathy occurs mostly subclinically as early as the first year of life. The current study of a large national A-T cohort demonstrates that development of neuropathy in A-T differs in the upper and lower extremities.
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Affiliation(s)
- Marius Theis
- Department for Children and Adolescents, Division of Pediatric Neurology, Neurometabolics, and Prevention, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Helena Donath
- Department for Children and Adolescents, Division of Allergology, Pulmonology, and Cystic Fibrosis, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Sandra Woelke
- Department for Children and Adolescents, Division of Allergology, Pulmonology, and Cystic Fibrosis, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Shahrzad Bakhtiar
- Department for Children and Adolescents, Division for Stem Cell Transplantation, Immunology, and Intensive Care Medicine, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Stem Cell Transplantation, Immunology, and Intensive Care Medicine, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology, and Cystic Fibrosis, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Matthias Kieslich
- Department for Children and Adolescents, Division of Pediatric Neurology, Neurometabolics, and Prevention, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
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Latronico N, Rasulo FA, Eikermann M, Piva S. Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes. Crit Care 2023; 27:439. [PMID: 37957759 PMCID: PMC10644573 DOI: 10.1186/s13054-023-04676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage. MAIN BODY CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient's condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician. CONCLUSIONS Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
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Dunker Ø, Uglem M, Bu Kvaløy M, Løseth S, Hjelland IE, Allen SM, Dehli Vigeland M, Kleggetveit IP, Sand T, Nilsen KB. Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity. BMJ Open Diabetes Res Care 2023; 11:e003545. [PMID: 37989346 PMCID: PMC10660161 DOI: 10.1136/bmjdrc-2023-003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy. RESEARCH DESIGN AND METHODS Five Norwegian university hospitals recruited patients with diabetes aged 18-70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy. RESULTS In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40). CONCLUSIONS This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.
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Affiliation(s)
- Øystein Dunker
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marie Bu Kvaløy
- Department of Neurology, Section of Clinical Neurophysiology, Stavanger University Hospital, Stavanger, Norway
| | - Sissel Løseth
- Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
| | - Ina Elen Hjelland
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
| | - Sara Maria Allen
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | | | - Inge Petter Kleggetveit
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Bernhard Nilsen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
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Coelho T, Marques W, Dasgupta NR, Chao CC, Parman Y, França MC, Guo YC, Wixner J, Ro LS, Calandra CR, Kowacs PA, Berk JL, Obici L, Barroso FA, Weiler M, Conceição I, Jung SW, Buchele G, Brambatti M, Chen J, Hughes SG, Schneider E, Viney NJ, Masri A, Gertz MR, Ando Y, Gillmore JD, Khella S, Dyck PJB, Waddington Cruz M. Eplontersen for Hereditary Transthyretin Amyloidosis With Polyneuropathy. JAMA 2023; 330:1448-1458. [PMID: 37768671 PMCID: PMC10540057 DOI: 10.1001/jama.2023.18688] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Importance Transthyretin gene silencing is an emerging treatment strategy for hereditary transthyretin (ATTRv) amyloidosis. Objective To evaluate eplontersen, an investigational ligand-conjugated antisense oligonucleotide, in ATTRv polyneuropathy. Design, Setting, and Participants NEURO-TTRansform was an open-label, single-group, phase 3 trial conducted at 40 sites across 15 countries (December 2019-April 2023) in 168 adults with Coutinho stage 1 or 2 ATTRv polyneuropathy, Neuropathy Impairment Score 10-130, and a documented TTR variant. Patients treated with placebo from NEURO-TTR (NCT01737398; March 2013-November 2017), an inotersen trial with similar eligibility criteria and end points, served as a historical placebo ("placebo") group. Interventions Subcutaneous eplontersen (45 mg every 4 weeks; n = 144); a small reference group received subcutaneous inotersen (300 mg weekly; n = 24); subcutaneous placebo weekly (in NEURO-TTR; n = 60). Main Outcomes and Measures Primary efficacy end points at week 65/66 were changes from baseline in serum transthyretin concentration, modified Neuropathy Impairment Score +7 (mNIS+7) composite score (scoring range, -22.3 to 346.3; higher scores indicate poorer function), and Norfolk Quality of Life Questionnaire-Diabetic Neuropathy (Norfolk QoL-DN) total score (scoring range, -4 to 136; higher scores indicate poorer quality of life). Analyses of efficacy end points were based on a mixed-effects model with repeated measures adjusted by propensity score weights. Results Among 144 eplontersen-treated patients (mean age, 53.0 years; 69% male), 136 (94.4%) completed week-66 follow-up; among 60 placebo patients (mean age, 59.5 years; 68% male), 52 (86.7%) completed week-66 follow-up. At week 65, adjusted mean percentage reduction in serum transthyretin was -81.7% with eplontersen and -11.2% with placebo (difference, -70.4% [95% CI, -75.2% to -65.7%]; P < .001). Adjusted mean change from baseline to week 66 was lower (better) with eplontersen vs placebo for mNIS+7 composite score (0.3 vs 25.1; difference, -24.8 [95% CI, -31.0 to -18.6; P < .001) and for Norfolk QoL-DN (-5.5 vs 14.2; difference, -19.7 [95% CI, -25.6 to -13.8]; P < .001). Adverse events by week 66 that led to study drug discontinuation occurred in 6 patients (4%) in the eplontersen group vs 2 (3%) in the placebo group. Through week 66, there were 2 deaths in the eplontersen group consistent with known disease-related sequelae (cardiac arrhythmia; intracerebral hemorrhage); there were no deaths in the placebo group. Conclusions and Relevance In patients with ATTRv polyneuropathy, the eplontersen treatment group demonstrated changes consistent with significantly lowered serum transthyretin concentration, less neuropathy impairment, and better quality of life compared with a historical placebo. Trial Registration ClinicalTrials.gov Identifier: NCT04136184; EU Clinical Trials Register: EudraCT 2019-001698-10.
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Affiliation(s)
- Teresa Coelho
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Wilson Marques
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil
| | | | | | - Yeşim Parman
- İstanbul Üniversitesi–Istanbul Tıp Fakültesi, Istanbul, Turkey
| | | | | | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Long-Sun Ro
- Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | | | - Pedro A. Kowacs
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
| | - John L. Berk
- Boston University School of Medicine, Boston, Massachusetts
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Markus Weiler
- Amyloidosis Center and Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Isabel Conceição
- Centro Hospitalar Universitário Lisboa-Norte, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | | | - Jersey Chen
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Ahmad Masri
- OHSU Center for Hypertrophic Cardiomyopathy and Amyloidosis, Portland, Oregon
| | | | - Yukio Ando
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Julian D. Gillmore
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Sami Khella
- University of Pennsylvania School of Medicine, Philadelphia
| | | | - Márcia Waddington Cruz
- Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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McNeish BL, Kolb N. Toxic Neuropathies. Continuum (Minneap Minn) 2023; 29:1444-1468. [PMID: 37851038 DOI: 10.1212/con.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an overview and update on the most clinically relevant toxic neuropathies. LATEST DEVELOPMENTS Broadly, toxic neuropathies were previously quite rare with the notable exception of neuropathy from alcohol or older chemotherapeutics. The development of newer therapies, particularly immunotherapy to treat malignancy, has resulted in a substantial increase in the occurrence of toxic neuropathies that require timely recognition and treatment. The understanding of other toxic neuropathies continues to evolve, such as statin-induced neuropathy, which new evidence suggests is much less common than previously suspected. ESSENTIAL POINTS Toxic neuropathies can be caused by medications, supplements, and recreational substances that injure peripheral nerves. Medications have evolved in the past 2 decades, as have the types of neuropathies that can be seen as related toxicities. In some areas of medicine, new classes and generations of drugs are associated with a lower incidence of toxic neuropathy.
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Beydoun SR, Darki L. Paraproteinemic Neuropathies. Continuum (Minneap Minn) 2023; 29:1492-1513. [PMID: 37851040 DOI: 10.1212/con.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Coexistence of polyneuropathy and gammopathy is a common but potentially challenging situation in clinical practice. This article reviews the clinical, electrophysiologic, and hematologic phenotypes of the paraproteinemic neuropathies and the diagnostic and treatment strategies for each. LATEST DEVELOPMENTS Advances in our understanding of the underlying pathophysiology of various paraproteinemic neuropathies and their corresponding phenotypes have identified potential new therapeutic targets. Therapeutic strategies to diminish anti-myelin-associated glycoprotein (MAG) IgM antibodies have shown partial and inconsistent efficacy; however, antigen-specific immune therapy is being investigated as a novel treatment to remove the presumably pathogenic anti-MAG antibody. Advances in genetic and cell signaling studies have resulted in the approval of Bruton tyrosine kinase inhibitors for Waldenström macroglobulinemia. Monoclonal antibodies are being investigated for the treatment of light chain amyloidosis. ESSENTIAL POINTS Early recognition and treatment of underlying plasma cell disorders improves clinical outcomes in patients with paraproteinemic neuropathy. Despite significant progress, our knowledge regarding underlying mechanisms for paraproteinemic neuropathy is still limited. Clinicians' awareness of clinical phenotypes, electrophysiologic hallmarks, and hematologic findings of the different paraproteinemic neuropathies is crucial to promptly identify and treat patients and to avert misdiagnosis. Multidisciplinary collaboration among specialists, including neurologists and hematologists, is paramount for the optimal treatment of these patients with overlapping conditions.
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Calikoglu BF, Celik S, Idiz C, Bagdemir E, Issever H, Calvet JH, Satman I. Electrochemical skin conductances values and clinical factors affecting sudomotor dysfunction in patients with prediabetes, type 1 diabetes, and type 2 diabetes: A single center experience. Prim Care Diabetes 2023; 17:499-505. [PMID: 37394312 DOI: 10.1016/j.pcd.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND AND AIM Sudomotor dysfunction is linked to small fibers damage. We investigated sudomotor dysfunction in a large group of participants with diabetes, prediabetes, and nondiabetic healthy subjects. This study aimed to complete knowledge on sudomotor dysfunction in this population, especially regarding the threshold values for the electrochemical skin conductance (ESC) and factors affecting it. MATERIALS AND METHODS A total of 690 volunteers in four groups were included in the study (type 1 [T1DG]: n = 80, 61.3% women; type 2 diabetes [T2DG]: n = 438, 63.5% women; prediabetes [Pre-DG]: n = 88, 80.7% women; healthy control [HC-G]: n = 84, 67.5% women). All subjects were investigated for clinical diabetic peripheral polyneuropathy and sudomotor dysfunction. The characteristics of participants obtained from outpatient records were evaluated. We used the Sudoscan device to measure ESC which was normalized for BMI, to improve the discriminative capability of the method. RESULTS Diabetic polyneuropathy was found in 17.5% of T1DG, 27.4% of T1DG, and 10.2% of Pre-DG. The mean ESC/BMI was lower in subgroups with diabetic polyneuropathy than those without. Mean ESC/BMI was lowest in T2DG and highest in HC-G but comparable in T1DG and Pre-DG. We accepted the "mean ESC/BMI-1 SD" in the HC-G as the threshold for sudomotor dysfunction. Accordingly, the prevalence of sudomotor dysfunction was 18.8%, 44.3%, 59.1%, and 15% in T1DG, T2DG, Pre-DG, and HC-G, respectively. In T2DG, sudomotor dysfunction was found in 66.7% of persons with retinopathy, of which 56.3% had clinical diabetic polyneuropathy. The prevalence of sudomotor dysfunction in subjects with peripheral artery disease, chronic kidney disease, cardiovascular disease, and hypertension was 46.7%, 47.4%, 43.4%, and 50%, respectively, and 42.9%, 38.9%, 45.5%, and 37.3% of whom in the same order detected with clinical diabetic polyneuropathy. Considering the entire group, a logistic regression model demonstrated that the variables associated with SMD were: retinopathy (OR: 2.969; 95% CI: 1.723, 5.114), female gender (OR: 1.952; 95% CI: 1.287, 2.962), and e-GFR (OR: 0.989; 95% CI: 0.981, 0.998). Since the rate of complications was very low in T1DG, excluding this group, a new model similarly revealed that retinopathy and female gender were associated with SMD, however, the association with e-GFR was disappeared. CONCLUSION The prevalence of sudomotor dysfunction is high when established peripheral polyneuropathy was present in diabetes. Even though, sudomotor dysfunction can also occur before clinical polyneuropathy in both types of diabetes (T1DG: 18.8%, T2DG 44.3%), prediabetes (59.1%), and nondiabetic healthy subjects (15%). The variables associated with sudomotor dysfunction were retinopathy and female sex. Normalization of ESC for BMI would be a beneficial approach. However, before this method is included in the routine screening programs for diabetic polyneuropathy, large-scale and prospective studies are required to reach a consensus on the pathological threshold values.
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Affiliation(s)
- Bedia Fulya Calikoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Selda Celik
- University of Health Sciences Turkey, Hamidiye Faculty of Nursing, Department of Internal Medicine, Istanbul, Turkiye
| | - Cemile Idiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Elif Bagdemir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Halim Issever
- Division of Medical Sciences, Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | | | - Ilhan Satman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye.
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Tajiri M, Kodaira M, Nakamura K, Sekijima Y. Tongue Hemiatrophy in Multifocal Motor Neuropathy. Intern Med 2023; 62:2759-2760. [PMID: 36642526 PMCID: PMC10569914 DOI: 10.2169/internalmedicine.1329-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Masateru Tajiri
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Minori Kodaira
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Katsuya Nakamura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Yang J, Yang X, Wu G, Huang F, Shi X, Wei W, Zhang Y, Zhang H, Cheng L, Yu L, Shang J, Lv Y, Wang X, Zhai R, Li P, Cui B, Fang Y, Deng X, Tang S, Wang L, Yuan Q, Zhao L, Zhang F, Zhang C, Yuan H. Gut microbiota modulate distal symmetric polyneuropathy in patients with diabetes. Cell Metab 2023; 35:1548-1562.e7. [PMID: 37451270 DOI: 10.1016/j.cmet.2023.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
The pathogenic mechanisms underlying distal symmetric polyneuropathy (DSPN), a common neuropathy in patients with diabetes mellitus (DM), are not fully understood. Here, we discover that the gut microbiota from patients with DSPN can induce a phenotype exhibiting more severe peripheral neuropathy in db/db mice. In a randomized, double-blind, and placebo-controlled trial (ChiCTR1800017257), compared to 10 patients who received placebo, DSPN was significantly alleviated in the 22 patients who received fecal microbiota transplants from healthy donors, independent of glycemic control. The gut bacterial genomes that correlated with the Toronto Clinical Scoring System (TCSS) score were organized in two competing guilds. Increased guild 1, which had higher capacity in butyrate production, and decreased guild 2, which harbored more genes in synthetic pathway of endotoxin, were associated with improved gut barrier integrity and decreased proinflammatory cytokine levels. Moreover, matched enterotype between transplants and recipients showed better therapeutic efficacy with more enriched guild 1 and suppressed guild 2. Thus, changes in these two competing guilds may play a causative role in DSPN and have the potential for therapeutic targeting.
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Affiliation(s)
- Junpeng Yang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xueli Yang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Guojun Wu
- State Key Laboratory of Microbial Metabolism and Ministry of Education Key Laboratory of Systems Biomedicine, Rutgers-SJTU Joint Laboratory on Microbiome and Human Health, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China; Department of Biochemistry and Microbiology and New Jersey Institute for Food, Nutrition, and Health, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901, USA
| | - Fenglian Huang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xiaoyang Shi
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Wei Wei
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Yingchao Zhang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Haihui Zhang
- Department of Gastroenterology of Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Lina Cheng
- Department of Gastroenterology of Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Lu Yu
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Jing Shang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Yinghua Lv
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xiaobing Wang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Rui Zhai
- State Key Laboratory of Microbial Metabolism and Ministry of Education Key Laboratory of Systems Biomedicine, Rutgers-SJTU Joint Laboratory on Microbiome and Human Health, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Pan Li
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, China
| | - Bota Cui
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, China
| | - Yuanyuan Fang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xinru Deng
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Shasha Tang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Limin Wang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Qian Yuan
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Liping Zhao
- State Key Laboratory of Microbial Metabolism and Ministry of Education Key Laboratory of Systems Biomedicine, Rutgers-SJTU Joint Laboratory on Microbiome and Human Health, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China; Department of Biochemistry and Microbiology and New Jersey Institute for Food, Nutrition, and Health, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901, USA.
| | - Faming Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; Key Laboratory of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, China.
| | - Chenhong Zhang
- State Key Laboratory of Microbial Metabolism and Ministry of Education Key Laboratory of Systems Biomedicine, Rutgers-SJTU Joint Laboratory on Microbiome and Human Health, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Huijuan Yuan
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China.
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19
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Pernice HF, Hahn K. [Neurological manifestations of ATTR amyloidosis]. Inn Med (Heidelb) 2023; 64:848-854. [PMID: 37555967 DOI: 10.1007/s00108-023-01570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
Transthyretin amyloidosis (ATTR) is a rare disease in which the protein transthyretin (TTR) is deposited in the form of amyloid fibrils in various tissues and organs and secondarily leads to functional impairment, especially in peripheral nerves and the heart. A differentiation is made between hereditary and sporadic forms. The hereditary variant is inherited in an autosomal dominant manner and usually occurs in the younger to middle-aged, while the sporadic form occurs in older age and has no known genetic cause. Typical signs of hereditary ATTR amyloidosis (ATTRv, v for variant) include a rapidly progressing sensorimotor and autonomic polyneuropathy (PNP), cardiac dysfunction as well as ocular and gastrointestinal symptoms. A carpal tunnel syndrome often precedes the manifestation. Various options (tafamidis, patisiran, inotersen or vutrisiran) are available for the treatment of patients with ATTRv with PNP in Germany, depending on the severity. In the sporadic variant of wild-type ATTR amyloidosis (ATTRwt), symptoms of progressive cardiomyopathy are usually prominent; however, neurological assessment of these patients often also reveals a concomitant sensory ataxic PNP. The tetramer stabilizer tafamidis can be used for treatment. Because of this complex presentation, the management of patients with ATTR amyloidosis should be performed in interdisciplinary centers specialized in amyloidosis.
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Affiliation(s)
- Helena F Pernice
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Katrin Hahn
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, Berlin, Deutschland.
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20
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Peters E, Itani M, Kristensen AG, Terkelsen AJ, Krøigård T, Tankisi H, Jensen TS, Finnerup NB, Gylfadottir SS. Cardiovascular autonomic neuropathy in patients with type 2 diabetes with and without sensorimotor polyneuropathy. J Peripher Nerv Syst 2023; 28:450-459. [PMID: 37449440 DOI: 10.1111/jns.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular autonomic neuropathy (CAN) in patients with diabetes is associated with poor prognosis. We aimed to assess signs of CAN and autonomic symptoms and to investigate the impact of sensorimotor neuropathy on CAN by examining type 2 diabetes patients with (DPN [distal sensorimotor polyneuropathy]) and without distal sensorimotor polyneuropathy (noDPN) and healthy controls (HC). Secondarily, we aimed to describe the characteristics of patients with CAN. METHODS A population of 374 subjects from a previously described cohort of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) were included. Subjects were examined with the Vagus™ device for the diagnosis of CAN, where two or more abnormal cardiovascular autonomic reflex tests indicate definite CAN. Autonomic symptoms were assessed with Composite Autonomic Symptom Score 31 (COMPASS 31) questionnaire. DPN was defined according to the Toronto consensus panel definition. RESULTS Definite CAN was present in 22% with DPN, 7% without DPN and 3% of HC, and 91% of patients with definite CAN had DPN. Patients with DPN and definite CAN reported higher COMPASS 31 scores compared to patients with noDPN (20.0 vs. 8.3, p < 0.001) and no CAN (22.1 vs. 12.3, p = 0.01). CAN was associated with HbA1c and age in a multivariate logistic regression analysis but was not associated with IEFND or triglycerides. INTERPRETATION One in five patients with DPN have CAN and specific CAN characteristics may help identify patients at risk for developing this severe diabetic complication. Autonomic symptoms were strongly associated with having both DPN and CAN, but too unspecific for diagnosing CAN.
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Affiliation(s)
- Emil Peters
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mustapha Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Alexander G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra Sif Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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21
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Xu J, Cai M, Wang Z, Chen Q, Han X, Tian J, Jin S, Yan Z, Li Y, Lu B, Lu H. Phenylacetylglutamine as a novel biomarker of type 2 diabetes with distal symmetric polyneuropathy by metabolomics. J Endocrinol Invest 2023; 46:869-882. [PMID: 36282471 PMCID: PMC10105673 DOI: 10.1007/s40618-022-01929-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) with distal symmetric polyneuropathy (DSPN) is a disease involving the nervous system caused by metabolic disorder, while the metabolic spectrum and key metabolites remain poorly defined. METHODS Plasma samples of 30 healthy controls, 30 T2DM patients, and 60 DSPN patients were subjected to nontargeted metabolomics. Potential biomarkers of DSPN were screened based on univariate and multivariate statistical analyses, ROC curve analysis, and logistic regression. Finally, another 22 patients with T2DM who developed DSPN after follow-up were selected for validation of the new biomarker based on target metabolomics. RESULTS Compared with the control group and the T2DM group, 6 metabolites showed differences in the DSPN group (P < 0.05; FDR < 0.1; VIP > 1) and a rising step trend was observed. Among them, phenylacetylglutamine (PAG) and sorbitol displayed an excellent discriminatory ability and associated with disease severity. The verification results demonstrated that when T2DM progressed to DSPN, the phenylacetylglutamine content increased significantly (P = 0.004). CONCLUSION The discovered and verified endogenous metabolite PAG may be a novel potential biomarker of DSPN and involved in the disease pathogenesis.
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Affiliation(s)
- J. Xu
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - M. Cai
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Z. Wang
- Department of Emergency, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Q. Chen
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - X. Han
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - J. Tian
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - S. Jin
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Z. Yan
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Y. Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - B. Lu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - H. Lu
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
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22
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Maalmi H, Strom A, Petrera A, Hauck SM, Strassburger K, Kuss O, Zaharia OP, Bönhof GJ, Rathmann W, Trenkamp S, Burkart V, Szendroedi J, Ziegler D, Roden M, Herder C. Serum neurofilament light chain: a novel biomarker for early diabetic sensorimotor polyneuropathy. Diabetologia 2023; 66:579-589. [PMID: 36472640 PMCID: PMC9892145 DOI: 10.1007/s00125-022-05846-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS No established blood-based biomarker exists to monitor diabetic sensorimotor polyneuropathy (DSPN) and evaluate treatment response. The neurofilament light chain (NFL), a blood biomarker of neuroaxonal damage in several neurodegenerative diseases, represents a potential biomarker for DSPN. We hypothesised that higher serum NFL levels are associated with prevalent DSPN and nerve dysfunction in individuals recently diagnosed with diabetes. METHODS This cross-sectional study included 423 adults with type 1 and type 2 diabetes and known diabetes duration of less than 1 year from the prospective observational German Diabetes Study cohort. NFL was measured in serum samples of fasting participants in a multiplex approach using proximity extension assay technology. DSPN was assessed by neurological examination, nerve conduction studies and quantitative sensory testing. Associations of serum NFL with DSPN (defined according to the Toronto Consensus criteria) were estimated using Poisson regression, while multivariable linear and quantile regression models were used to assess associations with nerve function measures. In exploratory analyses, other biomarkers in the multiplex panel were also analysed similarly to NFL. RESULTS DSPN was found in 16% of the study sample. Serum NFL levels increased with age. After adjustment for age, sex, waist circumference, height, HbA1c, known diabetes duration, diabetes type, cholesterol, eGFR, hypertension, CVD, use of lipid-lowering drugs and use of non-steroidal anti-inflammatory drugs, higher serum NFL levels were associated with DSPN (RR [95% CI] per 1-normalised protein expression increase, 1.92 [1.50, 2.45], p<0.0001), slower motor (all p<0.0001) and sensory (all p≤0.03) nerve conduction velocities, lower sural sensory nerve action potential (p=0.0004) and higher thermal detection threshold to warm stimuli (p=0.023 and p=0.004 for hand and foot, respectively). There was no evidence for associations between other neurological biomarkers and DSPN or nerve function measures. CONCLUSIONS/INTERPRETATION Our findings in individuals recently diagnosed with diabetes provide new evidence associating higher serum NFL levels with DSPN and peripheral nerve dysfunction. The present study advocates NFL as a potential biomarker for DSPN.
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Affiliation(s)
- Haifa Maalmi
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Agnese Petrera
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Stefanie M Hauck
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
- Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
| | - Sandra Trenkamp
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology, Diabetology, Metabolism and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Diabetes and Cancer (IDC) & Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Baka P, Birklein F. [Neuropathic pruritus-Evidence-based treatment recommendations]. Nervenarzt 2023; 94:136-141. [PMID: 35951052 PMCID: PMC9898430 DOI: 10.1007/s00115-022-01369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 02/06/2023]
Abstract
Neuropathic pruritus is a previously neglected symptom of a wide range of neurological diseases. Peripheral nerve or root compression syndromes, space-occupying lesions of the central nervous system, chronic inflammatory neurological diseases and polyneuropathy can cause neuropathic pruritus. Even when the identification of the underlying neurological disease is successful, a direct causal treatment is not always possible, hence an effective symptomatic treatment remains the only therapeutic option. The purpose of this review article is to present the current literature on various therapeutic agents and options in the treatment of neuropathic pruritus.
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Affiliation(s)
- Panoraia Baka
- Klinik für Neurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Frank Birklein
- Klinik für Neurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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24
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Sabovchyk AY. EFFECT OF NON-ALCOHOLIC FATTY LIVER DISEASE ON THE COURSE OF DIABETIC POLYNEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Wiad Lek 2023; 76:2395-2400. [PMID: 38112355 DOI: 10.36740/wlek202311109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim: To study the peculiarities of diabetic polyneuropathy in patients with type 2 diabetes mellitus and concomitant NAFLD. PATIENTS AND METHODS Materials and methods: We examined 75 patients with type 2 diabetes mellitus, including 31 (41.3%) women and 44 (58.7%) men. The main group included 35 patients with NAFLD (46.7%), and the control group included 40 patients without NAFLD (53.3%). The severity of polyneuropathy was assessed using the Toronto clinical neuropathy score. The presence of neuropathic pain syndrome in patients allowed us to divide patients into groups with painful or painless forms of diabetic polyneuropathy. The electroneuromyographic examination was used to study nerve conduction parameters, namely peroneal motor nerve conduction velocity (PMNCV), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV). RESULTS Results: The proportion of patients who did not have diabetic polyneuropathy in the NAFLD group was 12.5%, and in the group without NAFLD - 87.2%. The frequency of diabetic polyneuropathy was higher in the main group, namely: mild, moderate, and severe polyneuropathy was 80%, 56% and 59.3%, respectively, compared to the control group - 20%, 44%, 40.7% (p=0.02). The painful form of DPN was more common in patients of the main group than in the control group, respectively 69.8% and 30.2% (p=0.01). The degree of liver fibrosis did not affect the course of DPN. The study of nerve conduction by PMNCV, SNAP, and SNCV parameters showed that PMNCV was higher in the NAFLD group, and SNAP and SNCV - in the control group, but without statistical significance (p>0.05). CONCLUSION Conclusions: In patients with type 2 diabetes mellitus, the presence of NAFLD affects the severity of diabetic polyneuropathy and increases the risk of painful DPN. The degree of liver fibrosis did not show an effect on the development of diabetic polyneuropathy. ENMG parameters did not demonstrate a statistically significant difference in the study groups.
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25
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Gorczyca-Siudak D, Dziemidok P. The 8-Week Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) as an Add-on Therapy in the Treatment of Symptomatic Diabetic Peripheral Polyneuropathy. Int J Environ Res Public Health 2022; 20:111. [PMID: 36612433 PMCID: PMC9819549 DOI: 10.3390/ijerph20010111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Frequency Rhythmic Electrical Modulated System (FREMS) is a method of transcutaneous treatment based on frequency-modulated electromagnetic neural stimulation. Its efficacy in neuropathic pain in diabetes mellitus still lacks enough research. METHODS A randomized, single-blind, sham-controlled trial in individuals with symmetric distal polyneuropathy (SDPN) as an add-on therapy compared to standard therapy with alpha-lipoic acid. Participants were randomized to FREMS and standard of care (SOC) versus SOC only. The primary outcome was a change from baseline in perceived pain assessed by visual analogue scale (VAS) after 5 days of treatment and after 8 weeks of follow-up between treatment groups. RESULTS After 5 days of treatment, patients in both groups felt significant reduction in pain as measured by VAS, although only FREMS treatment lasted for 8 weeks and induced a significant improvement in quality of life measured by EuroQol 5-Dimension 5-Level (EQ-5D-5L) and Clinical Global Impression of Change (CGI-C) questionnaires. There were non-significant differences observed in the instrument pain assessment. No relevant side effects were recorded during the study. CONCLUSIONS FREMS as an addition to alpha-lipoic acid therapy occurred to be a beneficial method of treatment in individuals with SDPN and was associated with improvements in pain severity, quality of life and clinical global improvement.
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26
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Mizrak HI, Hansen TW, Andersen JA, Rossing P, Rasmussen A, Hansen CS. Distal symmetrical polyneuropathy is present in all individuals with diabetes and foot ulcers - and does not associate with healing time. J Diabetes Complications 2022; 36:108353. [PMID: 36370668 DOI: 10.1016/j.jdiacomp.2022.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
We estimated the occurrence of diabetic neuropathy using six different diagnostic modalities in individuals with newly diagnosed diabetic foot ulcers (DFUs) and assessed the association with DFU healing time. All individuals with DFU had distal symmetrical polyneuropathy. Presence of neuropathy did not associate with ulcer healing time (p ≥ 0.12).
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Affiliation(s)
| | | | - Jonas Askø Andersen
- Steno Diabetes Center Copenhagen, Denmark; Orthopedic Department, North Zealand Hospital, Hillerød Hospital, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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27
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Tomita K, Tokugawa S, Inui G, Moriyasu S, Ikeuchi T, Touge H, Tajima F. Granulocyte-colony-stimulating Factor-resistant Neutropenia and Polyneuropathy Presenting as Severe Complications of Sjögren's Syndrome. Intern Med 2022; 61:3287-3291. [PMID: 35342136 PMCID: PMC9683808 DOI: 10.2169/internalmedicine.9092-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) has multi-dimensional manifestations, including neutropenia and polyneuropathy. We herein report a 76-year-old woman with pSS initially presenting as severe granulocyte-colony-stimulating factor (G-CSF)-refractory neutropenia and axonal sensorimotor polyneuropathies (SMP). Systemic glucocorticoid administration had reduced neutrophil-associated immunoglobulin G (NAIgG) on the neutrophil surface as detected using flow cytometry, resulting in the development of neutropenia. A patient with pSS concomitant with axonal SMP might show severe neutropenia as aggressive autoimmune disease. Neutropenia can be treated with systemic glucocorticoids based on the assessment of NAIgG on the neutrophil surface.
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Affiliation(s)
- Katsuyuki Tomita
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Japan
| | - Shinnosuke Tokugawa
- Center for Clinical Residency Program, National Hospital Organization Yonago Medical Center, Japan
| | - Genki Inui
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Japan
| | - Shotaro Moriyasu
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Tomoyuki Ikeuchi
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Japan
| | - Hirokazu Touge
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Japan
| | - Fuminari Tajima
- Department of Hematology and Oncology, National Hospital Organization Yonago Medical Center, Japan
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Aimo A, Castiglione V, Rapezzi C, Franzini M, Panichella G, Vergaro G, Gillmore J, Fontana M, Passino C, Emdin M. RNA-targeting and gene editing therapies for transthyretin amyloidosis. Nat Rev Cardiol 2022; 19:655-667. [PMID: 35322226 DOI: 10.1038/s41569-022-00683-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/19/2022]
Abstract
Transthyretin (TTR) is a tetrameric protein synthesized mostly by the liver and secreted into the plasma. TTR molecules can misfold and form amyloid fibrils in the heart and peripheral nerves, either as a result of gene variants in TTR or as an ageing-related phenomenon, which can lead to amyloid TTR (ATTR) amyloidosis. Some of the proposed strategies to treat ATTR amyloidosis include blocking TTR synthesis in the liver, stabilizing TTR tetramers or disrupting TTR fibrils. Small interfering RNA (siRNA) or antisense oligonucleotide (ASO) technologies have been shown to be highly effective for the blockade of TTR expression in the liver in humans. The siRNA patisiran and the ASO inotersen have been approved for the treatment of patients with ATTR variant polyneuropathy, regardless of the presence and severity of ATTR cardiomyopathy. Preliminary data show that therapy with patisiran improves the cardiac phenotype rather than only inducing disease stabilization in patients with ATTR variant polyneuropathy and concomitant ATTR cardiomyopathy, and this drug is being evaluated in a phase III clinical trial in patients with ATTR cardiomyopathy. Furthermore, ongoing phase III clinical trials will evaluate another siRNA, vutrisiran, and a novel ASO formulation, eplontersen, in patients with ATTR variant polyneuropathy or ATTR cardiomyopathy. In this Review, we discuss these approaches for TTR silencing in the treatment of ATTR amyloidosis as well as the latest strategy of genome editing with CRISPR-Cas9 to reduce TTR gene expression.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Claudio Rapezzi
- Cardiologic Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Maria Franzini
- Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | | | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Julian Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Andrade Lopes S, Fayolle D, Jornayvaz FR. [Diabetic neuropathy: an update]. Rev Med Suisse 2022; 18:1106-1109. [PMID: 35647748 DOI: 10.53738/revmed.2022.18.784.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diabetic neuropathy is a heterogeneous entity, grouping multiple disorders, of which the most classic form is distal symmetric polyneuropathy (DSPN). Its diagnosis is based in most cases on a compatible history and clinical examination. Screening for DSPN, to allow the implementation of preventive measures against its complications, remains the cornerstone of management, in the absence of specific treatment. In this article, we propose a review of the different forms of diabetic neuropathy and their management.
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Affiliation(s)
- Stéphanie Andrade Lopes
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - François R Jornayvaz
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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30
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Chen X, Shen Y, Wang Y, Li Y, Guo S, Liang Y, Wang X, Zhou S, Hu X, Ma K, Tian R, Fei W, Sheng Y, Cao H, Que H. Decreased accuracy of erythrocyte sedimentation rate in diagnosing osteomyelitis in diabetic foot infection patients with severe renal impairment: A retrospective cross-sectional study. PLoS One 2022; 17:e0265769. [PMID: 35320298 PMCID: PMC8942204 DOI: 10.1371/journal.pone.0265769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Rapid diagnosis and treatment of diabetic foot osteomyelitis (DFO) could reduce the risk of amputation and death in patients with diabetic foot infection (DFI). Erythrocyte sedimentation rate (ESR) is considered the most useful serum inflammatory marker for the diagnosis of DFO. However, whether severe renal impairment (SRI) affects its diagnostic accuracy has not been reported previously. OBJECTIVE To investigate the accuracy of ESR in diagnosing DFO in DFI patients with and without SRI. METHODS This was a retrospective cross-sectional study. From the inpatient electronic medical record system, the investigators extracted demographic information, diagnostic information, and laboratory test results of patients with DFI who had been hospitalized in Longhua Hospital from January 1, 2016 to September 30, 2021. Logistic regression was performed to analyze the interaction between ESR and SRI with adjustment for potential confounders. The area under the curve (AUC), cutoff point, sensitivity, specificity, prevalence, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were analyzed by receiver operating characteristic (ROC) curve analysis and VassarStats. RESULTS A total of 364 DFI patients were included in the analysis. The logistic regression analysis results showed that elevated ESR increased the probability of diagnosing DFO (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.75-3.28; adjusted P < 0.001); SRI was not associated with the diagnosis of DFO (adjusted OR, 3.20; 95% CI, 0.40-25.32; adjusted P = 0.271), but it had an obstructive effect on the diagnosis of DFO by ESR (adjusted OR, 0.48; 95% CI, 0.23-0.99; adjusted P = 0.048). ROC analysis in DFI patients without SRI revealed that the AUC of ESR to diagnose DFO was 0.76 (95% CI, 0.71-0.81), with the cutoff value of 45 mm/h (sensitivity, 67.8%; specificity, 78.0%; prevalence, 44.7%; PPV, 71.3%; NPV, 75.0%; LR+, 3.08; LR-, 0.41). In contrast, in patients with SRI, the AUC of ESR to diagnose DFO was 0.57 (95% CI, 0.40-0.75), with the cutoff value of 42 mm/h (sensitivity, 95.0%; specificity, 29.2%; prevalence, 45.5%; PPV, 52.8%; NPV, 87.5%; LR+, 1.34; LR-, 0.17). CONCLUSIONS The accuracy of ESR in diagnosing DFO in DFI patients with SRI is reduced, and it may not have clinical diagnostic value in these patients.
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Affiliation(s)
- Xin Chen
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiting Shen
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuying Wang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Li
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Thoracic Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuyu Guo
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue Liang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuanyu Wang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Siyuan Zhou
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojie Hu
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaiwen Ma
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Tian
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenting Fei
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuqin Sheng
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hengjie Cao
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huafa Que
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- * E-mail:
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Bäckryd E, Themistocleous A, Larsson A, Gordh T, Rice AS, Tesfaye S, Bennett DL, Gerdle B. Hepatocyte growth factor, colony-stimulating factor 1, CD40, and 11 other inflammation-related proteins are associated with pain in diabetic neuropathy: exploration and replication serum data from the Pain in Neuropathy Study. Pain 2022; 163:897-909. [PMID: 34433766 PMCID: PMC9009322 DOI: 10.1097/j.pain.0000000000002451] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 12/03/2022]
Abstract
ABSTRACT One in 5 patients with diabetes suffers from chronic pain with neuropathic characteristics, but the pathophysiological mechanisms underlying the development of neuropathic pain in patients with diabetic distal symmetrical polyneuropathy (DSP) are poorly understood. Systemic low-grade inflammation has been implicated, but there is still a considerable knowledge gap concerning its scope and meaning in this context. The aim of the study was to establish the broad inflammatory signature of painful diabetic DSP in serum samples from the Pain in Neuropathy Study, an observational cross-sectional multicentre study in which participants underwent deep phenotyping. In the present two cohorts exploration-replication study (180 participants in each cohort), serum samples from Pain in Neuropathy Study participants were analyzed with the Olink INFLAMMATION panel (Olink Bioscience, Uppsala, Sweden) that enables the simultaneous measurement of 92 inflammation-related proteins (mainly cytokines, chemokines, and growth factors). In both the exploration and the replication cohort, we identified a high-inflammation subgroup where 14 inflammation-related proteins in particular were associated with more neuropathy and higher pain intensity. The top 3 proteins were hepatocyte growth factor, colony-stimulating factor 1, and CD40 in both cohorts. In the exploratory cohort, additional clinical data were available, showing an association of inflammation with insomnia and self-reported psychological distress. Hence, this cross-sectional exploration-replication study seems to confirm that low-grade systemic inflammation is related to the severity of neuropathy and neuropathic pain in a subgroup of patients with diabetic DSP. The pathophysiological relevance of these proteins for the development of neuropathic pain in patients with diabetic DSP must be explored in more depth in future studies.
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andreas Themistocleous
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingom
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrew S.C. Rice
- Pain Research, Departmennt Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - David L. Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingom
| | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Avila-Smirnow D, Céspedes P, Reyes F, Angulo J, Cavagnaro A, Wegner A. Neuromuscular complications of severe COVID-19 in paediatric patients: medium-term follow-up. Neuromuscul Disord 2022; 32:486-492. [PMID: 35562241 PMCID: PMC8993496 DOI: 10.1016/j.nmd.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Neuromuscular complications in paediatric patients with severe coronavirus disease 2019 (COVID-19) are poorly characterised. However, adult patients with severe COVID-19 reportedly present with frequent neuromuscular complications that mainly include critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and focal neuropathies. We examined the records of all paediatric patients with severe COVID-19 who were mechanically ventilated and experienced neuromuscular complications from our single tertiary centre between March 2020 and August 2021. During this period, 4/36 (11%) patients admitted to the paediatric ICU who were mechanically ventilated experienced neuromuscular complications (one CIM, two focal neuropathies, and one CIP associated with plexopathy). In three of them, the gamma genetic variant of SARS-CoV-2 was identified. At the 4–5 month follow-up, three of our patients exhibited slight clinical improvement. We conclude that paediatric patients with severe COVID-19 may present neuromuscular complications similar to adults (11%), and their medium-term prognosis seems unfavourable.
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Affiliation(s)
- Daniela Avila-Smirnow
- Unidad de Neurología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Región Metropolitana 8330077, Chile; Unidad de Neurología, Servicio de Pediatría, Complejo Asistencial Dr. Sótero del Río, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana 8207257, Chile.
| | - Pamela Céspedes
- Unidad de Paciente Crítico Pediátrico, Servicio de Pediatría, Complejo Asistencial Dr. Sótero del Río, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana 8207257, Chile
| | - Felipe Reyes
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Complejo Asistencial Dr. Sótero del Río, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana 8207257, Chile
| | - Jenniffer Angulo
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, 8331150 Santiago, Chile
| | - Agustín Cavagnaro
- Unidad de Paciente Crítico Pediátrico, Servicio de Pediatría, Complejo Asistencial Dr. Sótero del Río, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana 8207257, Chile
| | - Adriana Wegner
- Unidad de Paciente Crítico Pediátrico, Servicio de Pediatría, Complejo Asistencial Dr. Sótero del Río, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana 8207257, Chile
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Baskar D, Menon D, Rao S, Pal PK. Hansen's disease presenting as polyneuropathy: an unusual presentation. Acta Neurol Belg 2022; 123:611-613. [PMID: 35157243 DOI: 10.1007/s13760-022-01887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Bönhof GJ, Sipola G, Strom A, Herder C, Strassburger K, Knebel B, Reule C, Wollmann JC, Icks A, Al-Hasani H, Roden M, Kuss O, Ziegler D. BOND study: a randomised double-blind, placebo-controlled trial over 12 months to assess the effects of benfotiamine on morphometric, neurophysiological and clinical measures in patients with type 2 diabetes with symptomatic polyneuropathy. BMJ Open 2022; 12:e057142. [PMID: 35115359 PMCID: PMC8814806 DOI: 10.1136/bmjopen-2021-057142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Diabetic sensorimotor polyneuropathy (DSPN) affects approximately 30% of people with diabetes, while around half of cases are symptomatic. Currently, there are only few pathogenetically oriented pharmacotherapies for DSPN, one of which is benfotiamine, a prodrug of thiamine with a high bioavailability and favourable safety profile. While benfotiamine has shown positive effects in preclinical and short-term clinical studies, no long-term clinical trials are available to demonstrate disease-modifying effects on DSPN using a comprehensive set of disease-related endpoints. METHODS AND ANALYSIS The benfotiamine on morphometric, neurophysiological and clinical measures in patients with type 2 diabetes trial is a randomised double-blind, placebo-controlled parallel group monocentric phase II clinical trial to assess the effects of treatment with benfotiamine compared with placebo in participants with type 2 diabetes and mild to moderate symptomatic DSPN. Sixty participants will be 1:1 randomised to treatment with benfotiamine 300 mg or placebo two times a day over 12 months. The primary endpoint will be the change in corneal nerve fibre length assessed by corneal confocal microscopy (CCM) after 12 months of benfotiamine treatment compared with placebo. Secondary endpoints will include other CCM measures, skin biopsy and function indices, variables from somatic and autonomic nerve function tests, clinical examination and questionnaires, general health, health-related quality of life, cost, safety and blood tests. ETHICS AND DISSEMINATION The trial was approved by the competent authority and the local independent ethics committee. Trial results will be published in peer-reviewed journals, conference abstracts, and via online and print media. TRIAL REGISTRATION NUMBER DRKS00014832.
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Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Gundega Sipola
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Birgit Knebel
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | | | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf at Heinrich-Heine-University, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Garmendia Prieto B, Pallardo Rodil B, Montero TL, Gómez-Pavón J. [Paraneoplastic sensory-motor peripheral polyneuropathy associated with anti-Ri: A case report]. Rev Esp Geriatr Gerontol 2022; 57:44-45. [PMID: 34906372 DOI: 10.1016/j.regg.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Blanca Garmendia Prieto
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España.
| | - Beatriz Pallardo Rodil
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Teresa Lapeña Montero
- Servicio de Neurología, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España
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36
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Bönhof GJ, Herder C, Ziegler D. Diagnostic Tools, Biomarkers, and Treatments in Diabetic polyneuropathy and Cardiovascular Autonomic Neuropathy. Curr Diabetes Rev 2022; 18:e120421192781. [PMID: 33845748 DOI: 10.2174/1573399817666210412123740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
The various manifestations of diabetic neuropathy, including distal symmetric sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN), are among the most prevalent chronic complications of diabetes. Major clinical complications of diabetic neuropathies, such as neuropathic pain, chronic foot ulcers, and orthostatic hypotension, are associated with considerable morbidity, increased mortality, and diminished quality of life. Despite the substantial individual and socioeconomic burden, the strategies to diagnose and treat diabetic neuropathies remain insufficient. This review provides an overview of the current clinical aspects and recent advances in exploring local and systemic biomarkers of both DSPN and CAN assessed in human studies (such as biomarkers of inflammation and oxidative stress) for better understanding of the underlying pathophysiology and for improving early detection. Current therapeutic options for DSPN are (I) causal treatment, including lifestyle modification, optimal glycemic control, and multifactorial risk intervention, (II) pharmacotherapy derived from pathogenetic concepts, and (III) analgesic treatment against neuropathic pain. Recent advances in each category are discussed, including non-pharmacological approaches, such as electrical stimulation. Finally, the current therapeutic options for cardiovascular autonomic complications are provided. These insights should contribute to a broader understanding of the various manifestations of diabetic neuropathies from both the research and clinical perspectives.
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Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
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Zhang Q, Man X, Wang W, Tang S, Wang Y, Feng Y, Du Y, Cong L. A case of alcoholic pellagra presenting with dementia and polyneuropathy. Neurol Sci 2021; 43:739-741. [PMID: 34735652 DOI: 10.1007/s10072-021-05717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Xiao Man
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Wenguang Wang
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Yujie Feng
- Center of Multiple Disciplinary Team, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Center of Multiple Disciplinary Team, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, Shandong, People's Republic of China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, China.
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Gonçalves AN, Lima LH, Balaratnasingam C, Agarwal A, Jorge R. VITREOUS HEMORRHAGE IN A PATIENT WITH POLYNEUROPATHY. Retin Cases Brief Rep 2021; 15:S42-S44. [PMID: 34171903 DOI: 10.1097/icb.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Annelise N Gonçalves
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto/São Paulo, Brazil
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia; and
| | | | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto/São Paulo, Brazil
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Porta F, Siri B, Chiesa N, Ricci F, Nika L, Sciortino P, Spada M. SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature. J Pediatr Endocrinol Metab 2021; 34:261-266. [PMID: 33544541 DOI: 10.1515/jpem-2020-0139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/04/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Biallelic mutations in the SLC25A19 gene impair the function of the thiamine mitochondrial carrier, leading to two distinct clinical phenotypes. Homozygosity for the c.530G > C mutation is invariably associated to Amish lethal microcephaly. The second phenotype, reported only in 8 patients homozygous for different non-Amish mutations (c.373G > A, c.580T > C, c.910G > A, c.869T > A, c.576G > C), is characterized by bilateral striatal necrosis and peripheral polyneuropathy. We report a new patient with the non-Amish SLC25A19 phenotype showing compound heterozygosity for the new variant c.673G > A and the known mutation c.373G > A. CASE PRESENTATION The natural history of non-Amish SLC25A19 deficiency is characterized by acute episodes of fever-induced encephalopathy accompanied by isolated lactic acidosis and Leigh-like features at magnetic resonance imaging (MRI). Acute episodes are prevented by high-dose thiamine treatment (600 mg/day). As shown in the new case, both mild clinical signs and basal ganglia involvement can precede the acute encephalopathic onset of the disease, potentially allowing treatment anticipation and prevention of acute brain damage. Peripheral axonal neuropathy, observed in 7 out of 9 patients, is not improved by thiamine therapy. In two early treated patients, however, peripheral neuropathy did not occur even on long-term follow-up, suggesting a potential preventive role of treatment anticipation also at the peripheral level. CONCLUSIONS Non-Amish SLC25A19 deficiency is an extra-rare cause of Leigh syndrome responsive to thiamine treatment. Ex adiuvantibus thiamine treatment is mandatory in any patient with Leigh-like features.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Siri
- Department of Pediatrics, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nicoletta Chiesa
- Department of Pediatrics, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Ricci
- Division of Child Neurology and Psychiatry, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lulash Nika
- Department of Neuroradiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Sciortino
- Department of Neuroradiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Cai Q, Wu C, Xu W, Liang Y, Liao S. Stiff-person syndrome coexisting with critical illness polyneuropathy: A case report. Medicine (Baltimore) 2020; 99:e23607. [PMID: 33327330 PMCID: PMC7738057 DOI: 10.1097/md.0000000000023607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Stiff-person syndrome (SPS) is an uncommon neurological disorder with autoimmune features. Here, we report a 60-year-old man with SPS associated with critical illness polyneuropathy (CIP). CIP was diagnosed during an episode of acute respiratory failure secondary to muscular rigidity and spasms, which has rarely been reported in this condition. The overlapping of CIP and SPS complicated the case. PATIENT CONCERNS A 60-year-old man presented with gradual onset of cramps, stiffness, and rigidity in his lower limbs 1 year before admission, which eventually led to inability to stand and walk. The persistent nature of his symptoms progressed to frequent acute episodes of dyspnea and he was admitted to intensive care unit (ICU). DIAGNOSIS SPS had been diagnosed after 2 tests of electromyography (EMG) and the detection of an elevated anti-GAD65 antibody titer. During the first EMG, low or absent compound muscle action potentials (CMAP), and sensory nerve action potentials (SNAP) were shown. Therefore, the diagnosis of SPS coexisting with CIP was made. INTERVENTIONS Symptomatic treatment was initiated with oral clonazepam (0.5 mg Bid) and baclofen (5 mg Bid). Intravenous immunoglobulin (IVIG) (0.4 g/kg/d) was administered for the patient for 5 days after admission. We observed a significant clinical improvement during the administration period, and the patient became ambulatory. OUTCOMES On follow-up, the patient reported complete relief of his pain and rigidity. LESSONS We report this special case to address the varied clinical features of SPS. Electrophysiological testing is an important diagnostic approach. Accurate recognition of the disease ensures that the patients can be given appropriate treatment without delay.
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Stirban OA, Zeller-Stefan H, Schumacher J, Gaus W, Ziegler D, Schuerholz T, Pop-Busui R. Treatment with benfotiamine in patients with diabetic sensorimotor polyneuropathy: A double-blind, randomized, placebo-controlled, parallel group pilot study over 12 months. J Diabetes Complications 2020; 34:107757. [PMID: 33069584 DOI: 10.1016/j.jdiacomp.2020.107757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Wilhelm Gaus
- Institute for Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Thomas Schuerholz
- Wörwag Pharma GmbH & Co. KG, Böblingen, Germany; InnoDiab Forschung GmbH, Essen, Germany
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, USA
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Abstract
PURPOSE OF REVIEW Many polyneuropathies cause significant neuropathic pain, resulting in substantial morbidity and reduced quality of life. Appropriate management is crucial for maintaining quality of life for patients with painful polyneuropathies. The US Food and Drug Administration (FDA) has only approved one new drug for painful diabetic neuropathy in the past decade, a topical capsaicin patch that was initially approved for the treatment of postherpetic neuralgia in 2009. Gabapentinoids and serotonin norepinephrine reuptake inhibitors (SNRIs) continue to have an advantage in safety profiles and efficacy. Other antiepileptic medications remain second-line agents because of fewer studies documenting efficacy. RECENT FINDINGS This article reviews recent literature on complementary and pharmacologic therapies for the management of painful polyneuropathies. Exercise has emerged as an important therapeutic tool and may also improve the underlying polyneuropathy in the setting of obesity, metabolic syndrome, and diabetes. SUMMARY The approach to management of painful polyneuropathies is multifactorial, using both pharmacologic and nonpharmacologic measures to improve pain severity and patient quality of life.
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Nissen TD, Meldgaard T, Nedergaard RW, Juhl AH, Jakobsen PE, Karmisholt J, Drewes AM, Brock B, Brock C. Peripheral, synaptic and central neuronal transmission is affected in type 1 diabetes. J Diabetes Complications 2020; 34:107614. [PMID: 32571684 DOI: 10.1016/j.jdiacomp.2020.107614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/06/2019] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
AIMS We hypothesized that adults with type 1 diabetes and severe polyneuropathy have alterations in neuronal transmission at different anatomical levels. The aims were to investigate upstream sensory neuronal activation in terms of peripheral, spinal, precortical, and cortical transmission. METHODS 48 participants with type-1 diabetes and polyneuropathy, and 21 age-matched healthy participants were included. Electrophysiological median nerve recordings were used to analyze peripheral transmission at Erb's point (P9-N11); spinal evoked potentials at Cv7 (P11-N14); subcortical evoked potentials at Oz (N14-P18); early cortical evoked potentials at CP5 (N20-P22); late cortical evoked potentials at C1 (N60-P80) and estimated cortical inter-peak latencies as measures of central conduction time. RESULTS In comparison to healthy, the presence of diabetes prolonged peripheral transmission at P9 and N11 (+0.49 ms, p = .000; +0.47 ms, p = .04, respectively), early cortical evoked potentials at CP5: N20 (+2.41 ms, p = .003) and P22 (+5.88 ms, p = .001) and cortical potentials at C1: N60 (+39.08 ms, p = .001) and P80 (+54.55 ms, p = .000) and central conduction time. Decreased amplitudes were shown peripherally (-2.13 μV, p = .000), spinally (-0.57 μV, p = .005) and pre-cortically (-0.22 μV, p = .004). In both healthy and people with diabetes increased central conduction time were associated with decreased parasympathetic tone (ρ = -0.52, p = .027; ρ = -0.35, p = .047, respectively). CONCLUSION Neuronal afferent transmission and brain responses were significantly impaired in diabetes and the presence of prolonged central conduction time is indicative of severe extensive neuronal damage. Trial registry number: EUDRA CT: 2013-004375-12; clinicaltrials.gov: NCT02138045.
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Affiliation(s)
- Thomas Dahl Nissen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Theresa Meldgaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Wiberg Nedergaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne H Juhl
- Department of Neurophysiology, Aalborg University Hospital, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Jesper Karmisholt
- Steno Diabetes Center North, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Region Hovedstaden, Gentofte, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Affiliation(s)
- Brian C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor
- Veterans Affairs Healthcare System, Ann Arbor, Michigan
| | - Ray S Price
- Veterans Affairs Healthcare System, Ann Arbor, Michigan
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, University of Pennsylvania, Philadelphia
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Reis de Matos M, Santos-Bezerra DP, Dias Cavalcante CDG, Xavier de Carvalho J, Leite J, Neves JAJ, Admoni SN, Passarelli M, Parisi MC, Correa-Giannella ML. Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:ijerph17093232. [PMID: 32384735 PMCID: PMC7246466 DOI: 10.3390/ijerph17093232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 01/27/2023]
Abstract
The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.
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Affiliation(s)
- Mozania Reis de Matos
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Daniele Pereira Santos-Bezerra
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | | | - Jacira Xavier de Carvalho
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Juliana Leite
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Jose Antonio Januario Neves
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Sharon Nina Admoni
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | - Marisa Passarelli
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Lipides (LIM-10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Avenida Dr. Arnaldo, 455, Sala 3305, Sao Paulo 01246-903, Brazil
| | - Maria Candida Parisi
- Divisao de Endocrinologia, Departamento de Clinica Medica, Faculdade de Medicina da Universidade Estadual de Campinas (UNICAMP), Rua Tessalia Vieira de Camargo, 126 – Cidade Universitaria, Campinas 13083-887, Brazil;
| | - Maria Lucia Correa-Giannella
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
- Correspondence:
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Yalachkov Y, Uhlmann V, Bergmann J, Soydaş D, Frisch S, Behrens M, Foerch C, Gehrig J. Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance. PLoS One 2020; 15:e0228679. [PMID: 32017808 PMCID: PMC6999893 DOI: 10.1371/journal.pone.0228679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Chronic autoimmune demyelinating polyneuropathies (CADP) result in impaired sensorimotor function. However, anecdotal clinical observations suggest the development of cognitive deficits during the course of disease. Methods We tested 16 patients with CADP (11 patients with chronic inflammatory demyelinating polyneuropathy, 4 patients with multifocal motor neuropathy and 1 patient with multifocal acquired demyelinating sensory and motor neuropathy) and 40 healthy controls (HC) with a neuropsychological test battery. Blood-brain-barrier dysfunction (BBBd) in patients was assessed retrospectively by analysing the cerebral spinal fluid (CSF) status at the time the diagnosis of CAPD was established. Results CADP patients failed on average in 1.7 out of 9 neuropsychological tests (SD ± 1.25, min. 0, max. 5). 50% of the CADP patients failed in at least two neuropsychological tests and 44.3% of the patients failed in at least two different cognitive domains. CADP patients exhibiting BBBd at the time of first diagnosis failed in more neuropsychological tests than patients with intact integrity of the BBB (p < 0.05). When compared directly with the HC group, CADP patients performed worse than HC in tests measuring information processing ability and speed as well as phonemic verbal fluency after adjusting for confounding covariates. Conclusions Our results suggest that mild to moderate cognitive deficits might be present in patients with CAPD. One possible tentative explanation, albeit strong evidence is still lacking for this pathophysiological mechanism, refers to the effect of autoimmune antibodies entering the CNS via the dysfunctional blood-brain barrier typically seen in some of the CADP patients.
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Affiliation(s)
- Yavor Yalachkov
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
- * E-mail:
| | - Valerie Uhlmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Bergmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Dilara Soydaş
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Stefan Frisch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
- Institute of Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marion Behrens
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Christian Foerch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Gehrig
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
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Kawarai T, Yamazaki H, Yamakami K, Tsukamoto-Miyashiro A, Kodama M, Rumore R, Caltagirone C, Nishino I, Orlacchio A. A novel AIFM1 missense mutation in a Japanese patient with ataxic sensory neuronopathy and hearing impairment. J Neurol Sci 2019; 409:116584. [PMID: 31783324 DOI: 10.1016/j.jns.2019.116584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Toshitaka Kawarai
- Department of Clinical Neuroscience, Tokushima University Graduate School, Tokushima, Japan.
| | - Hiroki Yamazaki
- Department of Clinical Neuroscience, Tokushima University Graduate School, Tokushima, Japan
| | - Kei Yamakami
- Department of Clinical Neuroscience, Tokushima University Graduate School, Tokushima, Japan
| | - Ai Tsukamoto-Miyashiro
- Neurology Service, Tokushima National Hospital, National Hospital Organization, Tokushima, Japan
| | - Mizuki Kodama
- Faculty of Medicine-Student Laboratory, Tokushima University Graduate School, Tokushima, Japan
| | - Roberto Rumore
- Laboratorio di Neurogenetica, Centro Europeo di Ricerca sul Cervello (CERC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Carlo Caltagirone
- Laboratorio di Neurologia Clinica e Comportamentale, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Antonio Orlacchio
- Laboratorio di Neurogenetica, Centro Europeo di Ricerca sul Cervello (CERC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy; Dipartimento di Scienze Chirurgiche e Biomediche, Università di Perugia, Perugia, Italy
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Cisarovsky C, Nguyen S, Vannotti M, Büla C, Kuntzer T. [Management of peripheral neuropathy in the elderly]. Rev Med Suisse 2019; 15:2039-2043. [PMID: 31696679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Polyneuropathies occur frequently (> 30 %) among elderly people and can result in increased morbidity and impaired quality of life. Diabetes, chronic kidney disease, water-soluble vitamins deficiencies, drugs and alcohol side effects are the major etiologies after a systematic assessment. Neurologist referral is indicated when the diagnosis remains unclear and therapeutic options exist. Treatment strategies focus on reversal of underlying conditions, prevention, stabilization and alleviation of symptoms, especially neuropathic pain and maintain the best autonomy.
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Affiliation(s)
| | - Sylvain Nguyen
- Service de gériatrie et réadaptation gériatrique, CHUV, 1011 Lausanne
| | - Matthias Vannotti
- Cabinet Lutrymed, FMH Médecine interne générale, Rue Verdaine 8A, 1095 Lutry
| | - Christophe Büla
- Service de gériatrie et réadaptation gériatrique, CHUV, 1011 Lausanne
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Oswiecimska J, Dawidziuk M, Gambin T, Ziora K, Marek M, Rzonca S, Guilbride DL, Jhangiani SN, Obuchowicz A, Sikora A, Lupski JR, Wiszniewski W, Gawlinski P. A Patient with Berardinelli-Seip Syndrome, Novel AGPAT2 Splicesite Mutation and Concomitant Development of Non-diabetic Polyneuropathy. J Clin Res Pediatr Endocrinol 2019; 11:319-326. [PMID: 30563316 PMCID: PMC6745459 DOI: 10.4274/jcrpe.galenos.2018.2018.0227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022] Open
Abstract
Primary polyneuropathy in the context of Seip-Berardinelli type 1 seipinopathy, or congenital generalized lipodystrophy type 1 (CGL1) has not been previously reported. We report the case history of a 27 year old female CGL1 patient presenting with an unusual additional development of non-diabetic peripheral neuropathy and learning disabilities in early adolescence. Whole exome sequencing (WES) of the patient genome identified a novel variant, homozygous for a 52 bp intronic deletion in the AGPAT2 locus, coding for 1-acylglycerol-3-phosphate O-acyltransferase 2, which is uniquely associated with CGL1 seipinopathies, with no molecular evidence for dual diagnosis. Functional studies using RNA isolated from patient peripheral blood leucocytes showed abnormal RNA splicing resulting in the loss of 25 amino acids from the patient AGPAT2 protein coding sequence. Stability and transcription levels for the misspliced AGPAT2 mRNA in our patient nonetheless remained normal. Any AGPAT2 protein produced in our patient is therefore likely to be dysfunctional. However, formal linkage of this deletion to the neuropathy observed remains to be shown. The classical clinical presentation of a patient with AGPAT2-associated lipodystrophy shows normal cognition and no development of polyneuropathy. Cognitive disabilities and polyneuropathy are features associated exclusively with clinical CGL type 2 arising from seipin (BSCL2) gene mutations. This case study suggests that in some genetic contexts, AGPAT2 mutations can also produce phenotypes with primary polyneuropathy.
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Affiliation(s)
- Joanna Oswiecimska
- Medical University of Silesia in Katowice, Department of Pediatrics in Zabrze, Silesia, Poland
| | - Mateusz Dawidziuk
- Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland
| | - Tomasz Gambin
- Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland
- Warsaw University of Technology, Institute of Computer Science, Warsaw, Poland
- Baylor College of Medicine, Department of Molecular and Human Genetics, Texas, USA
| | - Katarzyna Ziora
- Medical University of Silesia in Katowice, Department of Pediatrics in Zabrze, Silesia, Poland
| | - Marta Marek
- Medical University of Silesia in Katowice, Department of Pediatrics in Bytom, Silesia, Poland
| | - Sylwia Rzonca
- Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland
| | | | | | - Anna Obuchowicz
- Medical University of Silesia in Katowice, Department of Pediatrics in Bytom, Silesia, Poland
| | - Alicja Sikora
- Medical University of Silesia in Katowice, Department of Pediatrics in Bytom, Silesia, Poland
| | - James R. Lupski
- Baylor College of Medicine, Department of Molecular and Human Genetics, Texas, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Texas, USA
- Baylor College of Medicine, Department of Pediatrics, Texas, USA
- Texas Children’s Hospital, Texas, USA
| | - Wojciech Wiszniewski
- Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland
- Oregon Health and Science University, Department of Molecular and Medical Genetics, Portland, USA
| | - Pawel Gawlinski
- Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland
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Matthews CA, Deveshwar SP, Evans RJ, Badlani G, Walker SJ. Small fiber polyneuropathy as a potential therapeutic target in interstitial cystitis/bladder pain syndrome. Int Urogynecol J 2019; 30:1817-1820. [PMID: 31240362 DOI: 10.1007/s00192-019-04011-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/30/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Interstitial cystitis/bladder pain syndrome (IC/BPS) and fibromyalgia (FM) are frequently co-occurring medical diagnoses in patients referred to the urology clinic for secondary and tertiary treatment options. METHODS Abundant literature has shown that many patients with FM have small fiber polyneuropathy (SFPN) that can be confirmed via skin punch biopsy and immunological staining to measure nerve density. RESULTS AND CONCLUSIONS This finding of SFPN provides a therapeutic target for FM and in this article we hypothesize and provide rationale for the idea that this same phenomenon (SFPN) might explain, in some IC/BPS patients, the finding of widespread pain and likewise provide a therapeutic target for these patients.
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Affiliation(s)
- Catherine A Matthews
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Shaun P Deveshwar
- Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, 391 Technology Way, Winston Salem, NC, 27101, USA
| | - Robert J Evans
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gopal Badlani
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Stephen J Walker
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
- Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, 391 Technology Way, Winston Salem, NC, 27101, USA.
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