RESUMEN

Neuropathies secondary to tophus compression in gout patients are well known; however, limited data exist on other types of peripheral neuropathies (PN). Our aim was to describe PN frequency, characteristics, distribution, patterns, and associated factors in gout patients through clinical evaluation, a PN questionnaire, and nerve conduction studies (NCS). This cross-sectional descriptive study included consecutive gout patients (ACR/EULAR 2015 criteria) from our clinic. All underwent evaluation by Rheumatology and Rehabilitation departments, with IRB approval. Based on NCS, patients were categorized as PN + (presence) or PN- (absence). PN + patients were further classified as local peripheral neuropathy (LPN) or generalized somatic peripheral neuropathy (GPN). We enrolled 162 patients, 98% male (72% tophaceous gout). Mean age (SD): 49.4 (12) years; mean BMI: 27.9 (6.0) kg/m2. Comorbidities included dyslipidemia (53%), hypertension (28%), and obesity (23.5%). Abnormal NCS: 65% (n = 106); 52% LPN, 48% GPN. PN + patients were older, had lower education, and severe tophaceous gout. GPN patients were older, had lower education, and higher DN4 scores compared to LPN or PN- groups (p = 0.05); other risk factors were not significant. Over half of gout patients experienced neuropathy, with 48% having multiplex mononeuropathy or polyneuropathy. This was associated with joint damage and functional impairment. Mechanisms and risk factors remain unclear. Early recognition and management are crucial for optimizing clinical outcomes and quality of life in these patients. Key Points Peripheral neuropathies in gout patients had been scarcely reported and studied. This paper report that: • PN in gout is more frequent and more diverse than previously reported. • Mononeuropathies are frequent, median but also ulnar, peroneal and tibial nerves could be injured. • Unexpected, generalized neuropathies (polyneuropathy and multiplex mononeuropathy) are frequent and associated to severe gout. • The direct role of hyperuricemia /or gout in peripheral nerves require further studies.

Asunto(s)

Gota , Enfermedades del Sistema Nervioso Periférico , Humanos , Estudios Transversales , Gota/complicaciones , Gota/epidemiología , Masculino , Persona de Mediana Edad , Femenino , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/epidemiología , Adulto , Conducción Nerviosa , Comorbilidad , Síndromes de Compresión Nerviosa/complicaciones , Encuestas y Cuestionarios , Anciano , Factores de Riesgo

RESUMEN

Corticosteroids are a potential treatment to combat Complex Regional Pain Syndrome, however the adverse effect profile far outweighs the benefits of using them. Avascular necrosis and Osteonecrosis are among well defined adverse effects. Postmenopausal women are especially affected by corticosteroids due to loss of estrogen. Diabetics are an interesting study as their pain perception is altered due to either high cortisol levels or the development of peripheral neuropathy.

Asunto(s)

Osteonecrosis , Prednisolona , Distrofia Simpática Refleja , Femenino , Humanos , Ensayos Clínicos como Asunto , Neuropatías Diabéticas/complicaciones , Neuropatías Diabéticas/metabolismo , Estrógenos/metabolismo , Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Hidrocortisona/metabolismo , Neuralgia/complicaciones , Neuralgia/metabolismo , Osteonecrosis/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/metabolismo , Posmenopausia/metabolismo , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Prednisolona/uso terapéutico , Distrofia Simpática Refleja/tratamiento farmacológico , Medición de Riesgo

RESUMEN

Background: Posterior interosseous neuropathy is an uncommon cause of peripheral dystonia. Case Report: A 62-year-old man awakened and noticed right finger drop. A neurological examination revealed posterior interosseous neuropathy with dystonia-like finger movements. Abnormal movements were predominantly observed in the right thumb, ring finger, and little finger. Within 2 weeks, the muscle weakness in the right fingers had completely improved. However, a brief abnormal posture of the right thumb was persistent. Discussion: The residual abnormal posture of the right thumb may reflect pre-existing motor control abnormalities, which may have contributed to the onset of posterior interosseous neuropathy-associated peripheral dystonia.

Asunto(s)

Distonía , Humanos , Masculino , Persona de Mediana Edad , Distonía/fisiopatología , Distonía/etiología , Trastornos Distónicos/fisiopatología , Trastornos Distónicos/complicaciones , Trastornos Distónicos/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Dedos/fisiopatología

RESUMEN

Objective: To investigate the clinical and electrophysiological characteristics of ANCA-associated vasculitic neuropathy (VN) and analyze the predictors of treatment outcomes. Methods: Retrospective case series. In all, 652 consecutive patients with ANCA-associated vasculitis were admitted to the First Medical Center of the Chinese PLA General Hospital between January 2006 and December 2022. Peripheral neuropathy occurred in 91 patients. Patients were excluded if other known causes of neuropathy were present. Sixty-one patients were eventually enrolled, including 17 with eosinophilic granulomatosis with polyangiitis (EGPA), 11 with granulomatosis polyangiitis (GPA), and 33 with microscopic polyangiitis (MPA). Their clinical data were collected and clinical characteristics, VN manifestations, electrophysiological findings (including interside amplitude ratio [IAR]), and treatment outcomes were compared among the three subsets of AAV. Then, factors influencing the treatment outcomes were analyzed using multivariable logistic regression analysis. Results: Peripheral neuropathy occurred in 62.1%(18/29) of EGPA, 8.3%(15/180) of GPA, and 13.1%(58/443) of MPA patients. The age at onset and examination was higher in patients with MPA than those with EGPA or GPA (P<0.01). The occurrence of VN was later in patients with GPA than those with EGPA (P<0.01), and the GPA group had fewer affected nerves than the other two groups (P<0.016). The abnormal IARs of motor nerves in lower limbs were more detected in the EGPA than the MPA group (P<0.01). Logistic regression analysis suggested that higher Birmingham vasculitis activity score-version 3 (BVAS-V3) (OR=6.85, 95%CI 1.33-35.30) was associated with better treatment outcomes of VN. However, central nervous system involvement was a risk factor for poor treatment outcomes (OR=0.13, 95%CI 0.02-0.89). Conclusions: The clinical and electrophysiological characteristics of VN were slightly different among subsets of AAV. Patients with GPA often presented with polyneuropathy and had fewer nerves affected; mononeuritis multiplex was more common in EGPA than GPA and MPA. Higher BVAS-V3 and central nervous system involvement might predict the treatment outcome of VN.

Asunto(s)

Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos , Síndrome de Churg-Strauss , Granulomatosis con Poliangitis , Poliangitis Microscópica , Enfermedades del Sistema Nervioso Periférico , Humanos , Anticuerpos Anticitoplasma de Neutrófilos , Granulomatosis con Poliangitis/diagnóstico , Síndrome de Churg-Strauss/complicaciones , Estudios Retrospectivos , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Poliangitis Microscópica/complicaciones , Poliangitis Microscópica/diagnóstico , Resultado del Tratamiento , Enfermedades del Sistema Nervioso Periférico/complicaciones

RESUMEN

The immune system has a critical role in orchestrating tissue healing. As a result, regenerative strategies that control immune components have proved effective1,2. This is particularly relevant when immune dysregulation that results from conditions such as diabetes or advanced age impairs tissue healing following injury2,3. Nociceptive sensory neurons have a crucial role as immunoregulators and exert both protective and harmful effects depending on the context4-12. However, how neuro-immune interactions affect tissue repair and regeneration following acute injury is unclear. Here we show that ablation of the NaV1.8 nociceptor impairs skin wound repair and muscle regeneration after acute tissue injury. Nociceptor endings grow into injured skin and muscle tissues and signal to immune cells through the neuropeptide calcitonin gene-related peptide (CGRP) during the healing process. CGRP acts via receptor activity-modifying protein 1 (RAMP1) on neutrophils, monocytes and macrophages to inhibit recruitment, accelerate death, enhance efferocytosis and polarize macrophages towards a pro-repair phenotype. The effects of CGRP on neutrophils and macrophages are mediated via thrombospondin-1 release and its subsequent autocrine and/or paracrine effects. In mice without nociceptors and diabetic mice with peripheral neuropathies, delivery of an engineered version of CGRP accelerated wound healing and promoted muscle regeneration. Harnessing neuro-immune interactions has potential to treat non-healing tissues in which dysregulated neuro-immune interactions impair tissue healing.

Asunto(s)

Péptido Relacionado con Gen de Calcitonina , Macrófagos , Neutrófilos , Nociceptores , Cicatrización de Heridas , Animales , Ratones , Comunicación Autocrina , Péptido Relacionado con Gen de Calcitonina/metabolismo , Péptido Relacionado con Gen de Calcitonina/farmacología , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patología , Eferocitosis , Macrófagos/citología , Macrófagos/metabolismo , Monocitos/citología , Monocitos/metabolismo , Músculo Esquelético , Canal de Sodio Activado por Voltaje NAV1.8/deficiencia , Canal de Sodio Activado por Voltaje NAV1.8/genética , Canal de Sodio Activado por Voltaje NAV1.8/metabolismo , Neutrófilos/citología , Neutrófilos/metabolismo , Nociceptores/metabolismo , Comunicación Paracrina , Enfermedades del Sistema Nervioso Periférico/complicaciones , Proteína 1 Modificadora de la Actividad de Receptores/metabolismo , Regeneración/efectos de los fármacos , Piel , Trombospondina 1/metabolismo , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/inmunología , Humanos , Masculino , Femenino

RESUMEN

OBJECTIVE: To examine the associations between microvascular disease (MVD) and risk of stroke, dementia, and their major subtypes among individuals with type 2 diabetes mellitus (T2DM). METHODS: We included 26,173 participants with T2DM from the UK Biobank who had no known stroke or dementia at baseline. MVD burden was reflected by the presence of retinopathy, peripheral neuropathy, and chronic kidney disease. Cox regression models were used to estimate hazard ratios (HRs) and 95 % confidential intervals (CIs) of stroke and dementia associated with overall MVD burden and individual MVD. RESULTS: During a median follow-up of 11.5 years, 1103 incident stroke (964 ischemic and 269 hemorrhagic stroke) and 813 incident dementia (312 Alzheimer's disease and 304 vascular dementia) cases were identified. The risk of stroke, dementia, and their major subtypes all increased with an increasing number of MVD (all P-trend <0.001). The adjusted HRs (95 % CIs) comparing three with no MVD were 5.03 (3.16, 8.02) for all stroke, 4.57 (2.75, 7.59) for ischemic stroke, and 6.60 (2.65, 16.43) for hemorrhagic stroke. The corresponding estimates were 4.28 (2.33, 7.86) for all-cause dementia, 6.96 (3.02, 16.01) for Alzheimer's disease, and 3.81 (1.40, 10.42) for vascular dementia. Among the three MVD, chronic kidney disease showed the strongest associations with both stroke subtypes, while peripheral neuropathy was most strongly associated with both dementia subtypes. CONCLUSIONS: Risk of stroke, dementia, and their major subtypes increased with an increasing number of MVD. The associations of individual MVD with stroke and dementia varied substantially by types of MVD.

Asunto(s)

Enfermedad de Alzheimer , Demencia Vascular , Diabetes Mellitus Tipo 2 , Accidente Cerebrovascular Hemorrágico , Enfermedades del Sistema Nervioso Periférico , Insuficiencia Renal Crónica , Accidente Cerebrovascular , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Demencia Vascular/complicaciones , Enfermedad de Alzheimer/complicaciones , Accidente Cerebrovascular Hemorrágico/complicaciones , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo

RESUMEN

The resolution of the expert council is devoted to discussing aspects of the use of ipidacrine for the treatment of mononeuropathies, polyneuropathies and radiculopathies of various etiologies. Specialists prepared recommendations for ipidacrine's application in treating peripheral nervous system disorders.

Asunto(s)

Mononeuropatías , Enfermedades del Sistema Nervioso Periférico , Polineuropatías , Humanos , Sistema Nervioso Periférico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Polineuropatías/tratamiento farmacológico , Polineuropatías/etiología , Aminoquinolinas , Mononeuropatías/etiología

RESUMEN

INTRODUCTION/OBJECTIVE: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. METHODS: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. RESULTS: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P < .001), anxiety (27.0% vs 17.1%; P < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P = .036), obstructive sleep apnea (16.8% vs 11.6%; P = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P < .001), osteoarthritis (49.3% vs 26.1%; P < .001), other rheumatologic diseases (24.9% vs 19.4%; P = .006), and peripheral neuropathy (14.4% vs 5.3%; P < .001). CONCLUSION: Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.

Asunto(s)

Artritis Reumatoide , Dolor Crónico , Reflujo Gastroesofágico , Osteoartritis , Enfermedades del Sistema Nervioso Periférico , Enfermedad Pulmonar Obstructiva Crónica , Apnea Obstructiva del Sueño , Adulto , Humanos , Anciano , Femenino , Estados Unidos/epidemiología , Dolor Crónico/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/epidemiología , Apnea Obstructiva del Sueño/epidemiología , Osteoartritis/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Artritis Reumatoide/complicaciones

RESUMEN

REPORT: The rare association of Klinefelter syndrome and the clinical presentation of a late onset chronic progressive spastic paresis. CLINICAL PRESENTATION AND GENETICS: An infertile, 61-year-old man, presented with late adult onset of gait problems, deep muscle pain, and bladder problems. He presented for the first time, years after onset with a spastic paraparesis with high arched feet. His parents had already died, but the patient described high arched feet with his mother. There is no further certain information about the parents. After thorough investigation, an additional X chromosome was found, whereafter the diagnosis of Klinefelter syndrome could be made. Other acquired and genetic causes for spastic paraparesis or hereditary motor neuropathy are excluded. CONCLUSION: This rare case, together with three other literature reports by Sasaki (Intern Med 58(3):437-440, 2019), Sajra (Med Arh 61(1):52-53, 2007) and Matsubara et al., (J Neurol Neurosurg Psychiatry 57(5):640-642, 1994). suggests that Klinefelter syndrome can be associated with spastic paraparesis, besides the other various neuropsychiatric symptoms that are more commonly described.

Asunto(s)

Síndrome de Klinefelter , Paraparesia Espástica , Enfermedades del Sistema Nervioso Periférico , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Klinefelter/complicaciones , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Paraparesia Espástica/complicaciones , Paraparesia Espástica/genética , Enfermedades del Sistema Nervioso Periférico/complicaciones

RESUMEN

BACKGROUND: Despite the significant impact of chemotherapy-induced peripheral neuropathy on the quality of life for breast cancer survivors, there is a notable lack of comprehensive research. Therefore, a crucial need exists for further systematic investigation and inquiry into this matter. AIMS: This study examined predictors of quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy. DESIGN: A cross-sectional, correlational design. SETTINGS: This study was conducted at a medical center in northern Taiwan and a teaching hospital in northeastern Taiwan. PARTICIPANTS/SUBJECTS: One hundred and thirty adult women with breast cancer, who have undergone chemotherapy and obtained a Total Neuropathy Scale-Clinical Version score>0, were enrolled. METHODS: Neuropathic pain, sleep disturbances, depression, and quality of life were evaluated using multiple regression analysis to identify quality of life predictors. Clinical importance was established using the minimally important difference of Functional Assessment of Cancer Therapy-Breast. RESULTS: The study indicated that improving depression (B = -10.87, p < .001) and neuropathic pain (B = -8.33, p = .004) may enhance the quality of life of breast cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, the individual's marital status and family history of breast cancer were identified as predictive factors. CONCLUSIONS: This study illuminates quality of life determinants for breast cancer survivors with chemotherapy-induced peripheral neuropathy, advocating comprehensive care and addressing depression and neuropathic pain for better outcomes.

Asunto(s)

Antineoplásicos , Neoplasias de la Mama , Supervivientes de Cáncer , Neuralgia , Calidad de Vida , Humanos , Femenino , Calidad de Vida/psicología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/psicología , Estudios Transversales , Persona de Mediana Edad , Neuralgia/psicología , Neuralgia/inducido químicamente , Supervivientes de Cáncer/psicología , Supervivientes de Cáncer/estadística & datos numéricos , Taiwán , Adulto , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Anciano , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/psicología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Encuestas y Cuestionarios

RESUMEN

Guillain-Barré syndrome (GBS) is a rare heterogenous disorder of the peripheral nervous system, which is usually triggered by a preceding infection, and causes a potentially life-threatening progressive muscle weakness1. Although GBS is considered an autoimmune disease, the mechanisms that underlie its distinct clinical subtypes remain largely unknown. Here, by combining in vitro T cell screening, single-cell RNA sequencing and T cell receptor (TCR) sequencing, we identify autoreactive memory CD4+ cells, that show a cytotoxic T helper 1 (TH1)-like phenotype, and rare CD8+ T cells that target myelin antigens of the peripheral nerves in patients with the demyelinating disease variant. We characterized more than 1,000 autoreactive single T cell clones, which revealed a polyclonal TCR repertoire, short CDR3ß lengths, preferential HLA-DR restrictions and recognition of immunodominant epitopes. We found that autoreactive TCRß clonotypes were expanded in the blood of the same patient at distinct disease stages and, notably, that they were shared in the blood and the cerebrospinal fluid across different patients with GBS, but not in control individuals. Finally, we identified myelin-reactive T cells in the nerve biopsy from one patient, which indicates that these cells contribute directly to disease pathophysiology. Collectively, our data provide clear evidence of autoreactive T cell immunity in a subset of patients with GBS, and open new perspectives in the field of inflammatory peripheral neuropathies, with potential impact for biomedical applications.

Asunto(s)

Autoinmunidad , Linfocitos T CD8-positivos , Síndrome de Guillain-Barré , Nervios Periféricos , Enfermedades del Sistema Nervioso Periférico , Células TH1 , Humanos , Biopsia , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/patología , Síndrome de Guillain-Barré/sangre , Síndrome de Guillain-Barré/líquido cefalorraquídeo , Síndrome de Guillain-Barré/etiología , Síndrome de Guillain-Barré/inmunología , Antígenos HLA-DR/inmunología , Epítopos Inmunodominantes/inmunología , Vaina de Mielina/inmunología , Nervios Periféricos/inmunología , Nervios Periféricos/patología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/inmunología , Enfermedades del Sistema Nervioso Periférico/patología , Receptores de Antígenos de Linfocitos T/inmunología , Células TH1/inmunología , Células TH1/patología , Linfocitos T Citotóxicos/inmunología , Linfocitos T Citotóxicos/patología , Memoria Inmunológica

RESUMEN

BACKGROUND AND AIMS: Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. METHODS: Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. RESULTS: Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. INTERPRETATION: Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.

Asunto(s)

Síndrome de Guillain-Barré , Orientia tsutsugamushi , Enfermedades del Sistema Nervioso Periférico , Tifus por Ácaros , Humanos , Masculino , Femenino , Tifus por Ácaros/complicaciones , Tifus por Ácaros/diagnóstico , Tifus por Ácaros/epidemiología , Síndrome de Guillain-Barré/etiología , Síndrome de Guillain-Barré/complicaciones , Estudios Retrospectivos , Enfermedades del Sistema Nervioso Periférico/complicaciones , Parálisis

RESUMEN

PURPOSE: Impaired gait is one of the earliest, most devastating, and long-lasting symptoms associated with neurological disorders. This study tested the feasibility of wearing the NewGait rehabilitative device in individuals with gait impairments due to the most common neurological disorders. METHODS: Seven participants with gait impairments due to strokes, Multiple Sclerosis, peripheral neuropathies, Cerebral Palsy (CP) and Parkinson's Disease (PD) were included in the study. Their walking with and without wearing the NewGait was analyzed and compared using the Vicon T160 system for motion analysis. Gait velocity, step length, foot clearance, lateral displacement of the Center of Mass, gait deviation and symmetry indexes were compared using two standard deviation band method for each participant. RESULTS: Participants subjectively assessed the NewGait as a comfortable device to wear and showed immediate gait improvements to varying degrees. Most improvements were observed in participants with muscle weakness due to peripheral neuropathies, stroke, MS, and CP. These participants improved their foot clearance, gait velocity, and step length. Participants with cerebellar stroke and PD increased their gait stability. All participants demonstrated a reduction in composite gait deviation indexes. Not all gait parameters, though, showed immediate changes. CONCLUSION: The results suggest that the NewGait rehabilitative device is feasible and useful for correcting gait impairments caused by neurological deficits. Participants may need to wear this device for longer periods of time in order to achieve long lasting changes in the gait pattern, rather than an immediate correction.

Asunto(s)

Parálisis Cerebral , Trastornos Neurológicos de la Marcha , Enfermedad de Parkinson , Enfermedades del Sistema Nervioso Periférico , Dispositivos de Autoayuda , Accidente Cerebrovascular , Humanos , Enfermedades del Sistema Nervioso Periférico/complicaciones , Estudios de Factibilidad , Marcha/fisiología , Caminata/fisiología , Enfermedad de Parkinson/complicaciones , Accidente Cerebrovascular/complicaciones , Parálisis Cerebral/rehabilitación , Dispositivos de Autoayuda/efectos adversos , Trastornos Neurológicos de la Marcha/etiología , Fenómenos Biomecánicos

RESUMEN

INTRODUCTION: Nitrous oxide (NO) abuse is increasing among young people. This can result in severe neurological disorders such as myelopathy and/or peripheral neuropathy. We report the clinical presentations, biological, radiologic and electrophysiological findings of 5 patients hospitalized with neurological symptoms consecutive to NO abuse. In addition, a literature review was conducted to describe the neurological characteristics and to identify factors associated with a poor recovery. CASE REPORT: Among the 5 patients included, 2 had a myeloneuropathy, 2 had a sensorimotor neuropathy, and 1 had a normal spinal cord magnetic resonance imaging and electromyography despite neurological manifestations consistent with myeloneuropathy. After vitamin B 12 supplementation, recovery was reported in 4 patients, and 1 was lost to follow-up.From the literature review, 154 patients were included [94 males; median age 22 (19 to 26) y; NO exposure 9 (3 to 18) mo]. A myelopathy was identified in 116 patients (75%) and a peripheral neuropathy was documented in 89 patients (58%). Compared with patients who recovered, those with sequelae were more likely to have a motor deficit at presentation ( P <0.001), to use NO regularly ( P <0.001), to have a lower vitamin B 12 level ( P =0.04), and a higher concentration of homocysteine ( P =0.04). A less extensive myelopathy was more frequently found in the group with favorable outcomes ( P =0.002). CONCLUSION: Neurological disorders caused by NO may be challenging with severe clinical patterns. We identified several factors associated with a poor recovery, to make clinicians aware of NO-induced neurotoxicity.

Asunto(s)

Enfermedades del Sistema Nervioso , Enfermedades del Sistema Nervioso Periférico , Enfermedades de la Médula Espinal , Trastornos Relacionados con Sustancias , Masculino , Humanos , Adolescente , Adulto Joven , Adulto , Óxido Nitroso/efectos adversos , Vitamina B 12/efectos adversos , Enfermedades del Sistema Nervioso/inducido químicamente , Enfermedades de la Médula Espinal/inducido químicamente , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones

RESUMEN

In the context of burn injury, growth factors (GFs) play a significant role in mediating the complex local and systematic processes that occur. Among the many systemic complications that arise following a burn injury, peripheral neuropathy remains one of the most common. Despite the broad understanding of the effects GFs have on multiple tissues, their potential implications in both wound healing and neuropathy remain largely unexplored. Therefore, this review aims to investigate the expression patterns of GFs prominent during the burn wound healing process and explore the potential contributions these GFs have on the development of burn-related peripheral neuropathy.

Asunto(s)

Quemaduras , Enfermedades del Sistema Nervioso Periférico , Humanos , Quemaduras/complicaciones , Quemaduras/metabolismo , Enfermedades del Sistema Nervioso Periférico/complicaciones , Cicatrización de Heridas , Péptidos y Proteínas de Señalización Intercelular

RESUMEN

BACKGROUND AND PURPOSE: Despite thiamine deficiency being a lesser-known entity in modern times, beriberi in various forms, including thiamine deficiency-related neuropathy, remains endemic in Kashmir due to the consumption of polished rice as a staple food. This observational study investigates cases of peripheral neuropathy of unknown etiology and their potential responsiveness to thiamine administration. METHODS: This prospective study enrolled adult patients presenting to the emergency department with weakness consistent with thiamine deficiency-related neuropathy and conducted a therapeutic challenge with thiamine on 41 patients. Response to thiamine therapy was monitored based on subjective and objective improvements in weakness and power. Patients were divided into thiamine responders (n = 25) and nonresponders (n = 16) based on their response to thiamine therapy and nerve conduction studies. RESULTS: Most of the baseline characteristics were similar between responders and nonresponders, except the responders exhibited lower thiamine levels and higher partial pressure of oxygen and lactate levels compared to nonresponders. All patients had a history of consuming polished rice and traditional salt tea. Although weakness in the lower limbs was present in both groups, nonresponders were more likely to exhibit weakness in all four limbs. Clinical improvement was observed within 24 h, but proximal muscle weakness persisted for an extended period of time. CONCLUSIONS: Thiamine deficiency-related neuropathy presents with predominant lower limb weakness, exacerbated by vomiting, poor food intake, psychiatric illness, and pregnancy. Thiamine challenge should be followed by observation of clinical and biochemical response.

Asunto(s)

Beriberi , Enfermedades del Sistema Nervioso Periférico , Deficiencia de Tiamina , Adulto , Femenino , Embarazo , Humanos , Beriberi/complicaciones , Beriberi/tratamiento farmacológico , Estudios Prospectivos , Deficiencia de Tiamina/complicaciones , Deficiencia de Tiamina/tratamiento farmacológico , Tiamina/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Debilidad Muscular/etiología

RESUMEN

INTRODUCTION: Due to a COVID-related job loss resulting in financial and food insecurity, a 28-year-old woman initiated a diet consisting solely of one cup of ramen noodles daily for twenty-two months, leading to 27 kg of weight loss. Ramen noodles are low in calories and lack key nutrients, including potassium, chloride, and vitamin B12. CASE DESCRIPTION: The patient presented to the emergency department with acute, worsening weakness and paresthesias in her left wrist and hand. Exam revealed no other abnormalities aside from a cachectic appearance. Labs revealed marked hypokalemia, hypochloremia, lactic acidosis, a mixed metabolic alkalosis with respiratory acidosis, and low levels of zinc and copper. An EKG revealed a prolonged QT interval. After a neurology and psychiatry consult, the patient was admitted for failure to thrive with malnutrition, peripheral neuropathy, hypokalemia, and an acid-base disorder. An MRI of the brain was unremarkable. Studies of other nutritional deficiencies, autoimmune conditions, and sexually transmitted infections were unremarkable. The patient received food and vitamin supplementation, was monitored for re-feeding syndrome, and had a significant recovery. DISCUSSION: After stroke, spinal injury, multiple sclerosis, and the most common focal mononeuropathies were ruled out, the clinical focus turned to nutritional deficiencies, the most significant of which was hypokalemia. Prior research has shown that severe hypokalemia can lead to weakness. It has also shown that chronically insufficient dietary intake is a common cause of hypokalemia. This case, with its partial paralysis of a unilateral upper extremity, may add to the known clinical manifestations of hypokalemia. We review the role of hypokalemia and hypochloremia in acid-base dynamics. Etiologies and clinical manifestations of cobalamin, thiamine, pyridoxine, and copper deficiencies, along with lead toxicity, are also discussed. Diagnostic clarity of mononeuropathies in the context of malnutrition and hypokalemia can be aided by urine potassium levels prior to repletion, neuroimaging that includes the cervical spine, and follow-up electromyography.

Asunto(s)

Hipopotasemia , Desnutrición , Mononeuropatías , Enfermedades del Sistema Nervioso Periférico , Humanos , Femenino , Adulto , Hipopotasemia/diagnóstico , Cobre , Potasio , Paresia , Desnutrición/complicaciones , Parálisis/etiología , Parálisis/diagnóstico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Mononeuropatías/complicaciones

RESUMEN

This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.

Asunto(s)

Fracturas de Tobillo , Fracturas Abiertas , Enfermedades del Sistema Nervioso Periférico , Humanos , Anciano , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/complicaciones , Estudios Retrospectivos , Fracturas Abiertas/cirugía , Fijación Interna de Fracturas/efectos adversos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/terapia , Enfermedades del Sistema Nervioso Periférico/complicaciones , Albúmina Sérica , Resultado del Tratamiento

RESUMEN

Heavy metals even at low concentrations can damage all systems in the human body from the cellular level by causing disruptions in DNA repair mechanisms, cell division and apoptosis. A 49-year-old man who had been working in the sanding and deburring department of a factory producing underground water pipes for 15 years, presented with complaints of effort dyspnea, cough and loss of strength in his left hand. Computed tomography of the lung revealed diffuse micronodular appearance in all zones in both lungs, subpleural nodule and bronchial dilatation. All serological tests for autoimmune disease were negative. Neurological examination of the patient revealed signs of 2nd motor neuron involvement only in one upper extremity. All of the tests that were studied for the differential diagnosis of multifocal motor neuropathy were found negative. Open lung biopsy with videothoracoscopy was practiced and interstitial changes were observed in the lung parenchyma with intense iron accumulation with Prussian blue stain. The patient was diagnosed with hard metal lung disease (HMLD) and toxic neuropathy (TN) with peripheral nerve involvement due to exposure to metal dust in the working environment. Although the patient had no loss of lung function, he was removed from the working environment, because of function loss in the left hand and is still being followed up.

Asunto(s)

Enfermedades Pulmonares Intersticiales , Metales Pesados , Enfermedades del Sistema Nervioso Periférico , Masculino , Humanos , Persona de Mediana Edad , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/patología , Obreros Metalúrgicos , Pulmón/patología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/patología

RESUMEN

Globally, a leg is amputated approximately every 30 seconds, with an estimated 85 percent of these amputations being attributed to complications arising from diabetic foot ulcers (DFU), as stated by the American Diabetes Association. Peripheral arterial disease (PAD) is a risk factor resulting in DFU and can, either independently or in conjunction with diabetes, lead to recurring, slow-healing ulcers and amputations. According to guidelines amputation is the recommended treatment for patients with no-option critical ischemia of the limb (CTLI). In this article we propose cell therapy as an alternative strategy for those patients. We also suggest the optimal time-frame for an effective therapy, such as implanting autologous mononuclear cells (MNCs), autologous and allogeneic mesenchymal stromal cells (MSC) as these treatments induce neuropathy relief, regeneration of the blood vessels and tissues, with accelerated ulcer healing, with no serious side effects, proving that advanced therapy medicinal product (ATMPs) application is safe and effective and, hence, can significantly prevent limb amputation.

Asunto(s)

Diabetes Mellitus , Pie Diabético , Enfermedad Arterial Periférica , Enfermedades del Sistema Nervioso Periférico , Humanos , Pie Diabético/etiología , Pie Diabético/terapia , Factores de Riesgo , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Amputación Quirúrgica , Tratamiento Basado en Trasplante de Células y Tejidos , Isquemia/terapia , Isquemia/complicaciones