Critical appraisal of the use of alpha lipoic acid (thioctic acid) in the treatment of symptomatic diabetic polyneuropathy

Courtney E McIlduff, Seward B RutkoveDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USABackground: The most common of the neuropathies associated with diabetes mellitus, diabetic sensorimotor polyneuropathy (DSPN) is a syndrome of diffuse, length-dependent, symmetric nerve dysfunction. The condition is linked with substantial morbidity, frequent healthcare utilization, and compromised quality of life due to related discomfort. Correspondingly, antidepressants, anticonvulsants, and opioids are regularly prescribed with the goal of pain control. However, the agents rarely provide complete pain relief and fail to address progression of the disorder. Whereas strict blood glucose control can slow the onset and worsening of DSPN, near-normoglycemia is not easily attainable. Evidence implicating oxidative processes in the pathogenesis of DSPN offers one potentially important therapeutic avenue. Due to its properties as a potent antioxidant, alpha lipoic acid (ALA) could mitigate the development of DSPN and attenuate resultant symptoms and signs. Approved for treatment of DSPN in Germany, the agent is not more widely used due to uncertainty about its efficacy and reported adverse effects. Here we review the effectiveness and tolerability of ALA in the treatment of symptomatic DSPN.Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched for English-language literature on the topic. Randomized, blinded studies comparing parenteral and oral ALA with placebo in the treatment of peripheral neuropathy in diabetic adults were selected. Analysis included studies with a level of evidence of at least 2b.Results: The current appraisal summarizes data from 1160 participants in the ALADIN, SYDNEY, ORPIL, SYDNEY 2, and ALADIN III trials. In four of the studies, ALA provided significant improvement in manifestations of DSPN.Conclusion: Treatment with ALA 600 mg iv daily for 3 weeks represents a well-tolerated and effective therapy for DSPN. An oral dose of 600 mg daily administered for up to 5 weeks could offer benefits in symptoms and signs of DSPN without significant side effects.Keywords: alpha lipoic acid, antioxidant, diabetes mellitus, neuropathy, thioctic aci

Embedding the Model of Engaging with Communities Collaboratively (MECC) in the Jandu Yani U (For All Families) Project in Aboriginal communities of the Fitzroy Valley, Western Australia

This study evaluated the use of the Model of Engaging Communities Collaboratively (MECC) to guide the Jandu Yani U (For All Families) project, in which the Triple P – Positive Parenting Program was collaboratively adapted for use in very remote Aboriginal communities in Western Australia. The communities’ responses to the MECC processes were evaluated through interview-style or selfadministered surveys, semiformal interviews, focus group discussions and storytelling. The MECC processes were acceptable across all groups (mean score 3.86 on a 5-point acceptability scale). Qualitative data supported and gave context to the quantitative findings, demonstrating the acceptability and utility of the approach. The MECC provided a valuable framework for Aboriginal community engagement, program dissemination and implementation of research

Biomarkers in motor neuron disease: A state of the art review

Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data

Electrical Impedance Myography (EIM) and Quantitative Ultrasonography (QUS) Measurements of the Tongue: Biomarkers of Bulbar Dysfunction

Many neurological disorders are associated with speech and swallowing abnormalities. In turn, oropharyngeal dysfunction can negatively impact quality of life and survival. Reliable tools that quantify underlying motor deficits are needed for use in clinical care and therapeutic trials. As painless, non-invasive techniques, electrical impedance myography (EIM) and quantitative ultrasonography (QUS) are well-suited to provide biomarker data. Both of these user-friendly methods can provide sensitive indicators of disease status when applied to the limbs; existing work suggests that the examination of orofacial muscles could add valuable information. This document explores the role of EIM and QUS in evaluating tongue health and bulbar dysfunction in patients with neuromuscular conditions