A review on the investigation of peripheral neuropathy at Mater Dei Hospital

The term peripheral neuropathy encompasses a wide range of disorders. The underlying causes of peripheral neuropathy are diverse. It is very difficult to ascertain the incidence of peripheral neuropathy with any degree of certainty, but it is a manifestation of several common multisystem disorders, whose incidence is on the rise, such as diabetes and Human Immunodeficiency (HIV) virus infection. Worldwide, the population prevalence is about 2,400 per 100,000 (2.4%), rising with age to 8,000 per 100,000 (8%).1 Peripheral neuropathy can significantly impact an individual's quality of life especially if undiagnosed and untreated. Investigation of peripheral neuropathy is expensive and time consuming, and is best performed in a stepwise approach. Even in the best of circumstances, an aetiological diagnosis is not always achieved. At present, the existing guidelines deal with the treatment of peripheral neuropathy but there are none on how patients with peripheral neuropathy should be investigated.peer-reviewe

Self-Reported Physical Activity Using the International Physical Activity Questionnaire (IPAQ) in Australian Adults with Type 2 Diabetes, with and Without Peripheral Neuropathy

Objective: The aim of this study was to survey the level of self-reported physical activity in people with type 2 diabetes, with and without peripheral neuropathy. Methods: A sample of South Australian adults (n=481) aged 33-88 years with type 2 diabetes, including 55 people with peripheral neuropathy, completed the International Physical Activity Questionnaire (IPAQ). Levels of self-reported physical activity were compared between those with and without peripheral neuropathy. Results: People with type 2 diabetes and peripheral neuropathy (Mdn =1433, IQR = 495–3390 MET.min/wk) were less physically active than those without peripheral neuropathy (Mdn =2106, IQR = 876–4380 MET.min/wk) (p = 0.04). A total of 49% of people with type 2 diabetes and peripheral neuropathy met physical activity recommendations of 150 minutes of at least moderate activity per week, compared to 57% of people with type 2 diabetes alone. Conclusions: These findings demonstrate that people with type 2 diabetes and peripheral neuropathy reported being significantly less active than people with type 2 diabetes alone. People with type 2 diabetes and peripheral neuropathy need to be encouraged to perform higher levels of physical activity for biological, physical and psychological benefits. Further studies using objective measures of physical activity are required to support these results

Acupuncture Treatment for Bortezomib-Induced Peripheral Neuropathy: A Case Report

Peripheral neuropathy is a common and severe dose-limiting side effect of the chemotherapy agent, bortezomib, in multiple myeloma patients. Treatment with narcotics, antidepressants, and anticonvulsants has limited response and potential significant side effects. Acupuncture has been reported to be effective in treating diabetic neuropathy and chemo-induced peripheral neuropathy. There has not been report on the effect of acupuncture in treating bortezomib-induced peripheral neuropathy specifically. Here, we report a successful case of using acupuncture to relieve bortezomib-induced peripheral neuropathy symptoms

POEMS Syndrome Diagnosed 10 Years after Disabling Peripheral Neuropathy

Peripheral neuropathy is characterized as a generalized, relatively homogeneous process affecting many peripheral nerves and predominantly affecting distal nerves. The epidemiology of peripheral neuropathy is limited since the disease presents with varying etiology, pathology, and severity. Toxic, inflammatory, hereditary, and infectious factors can cause damage to the peripheral nerves resulting in peripheral neuropathy. Peripheral neuropathy is most commonly caused by diabetes, alcohol, HIV infection, and malignancy. We report a case of a 42-year-old female with 10-year history of progressively worsening peripheral neuropathy, hypothyroidism, and skin changes who presents with dyspnea secondary to recurrent pleural and pericardial effusions. Prior to her arrival, her peripheral neuropathy was believed to be secondary to chronic demyelinating inflammatory polyneuropathy (CDIP) given elevated protein in the cerebral spinal fluid (CSF) which was treated with intravenous immunoglobulin (IVIG) and corticosteroids. Unfortunately, her peripheral neuropathy did not have any improvement. Incidentally, patient was found to have splenomegaly and papilledema on physical exam. Serum protein electrophoresis showed a monoclonal pattern of IgA lambda. Patient met the diagnostic criteria for POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. An underlying diagnosis of POEMS syndrome should be considered in patients with chronic debilitating neuropathy and an elevated protein in the CSF

A study on peripheral neuropathy in HIV infected patients: clinicoepidemiological and electrophysiological profile

Background: Peripheral neuropathy is one among the commonest HIV-associated neurologic complications. The spectrum and the frequency of this complication are changing due to the introduction of new antiretroviral drugs, aging of the HIV-infected people, etc. Hence there is need for a better understanding of these complications and their pathogenesis. This study was done with the aim of finding out the risk factors, clinical characteristics and various types and patterns of peripheral neuropathy in HIV infected patients of our region.Methods: This study was a cross sectional study conducted for about a period of one year. Patients attending the out patient department of anti retroviral therapy (ART) centre were taken for the study. Selected patients were analysed for the signs and symptoms of peripheral neuropathy and they underwent electrophysiological study.Results: Prevalence of peripheral neuropathy in HIV infected patients in our study population was 43.3%. Peripheral neuropathy was seen more in patients with advanced clinical stage and increasing age. Distal symmetric polyneuropathy was the commonest type. Common pathological pattern of neuropathy was mixed (both axonal and demyelination) neuropathy.Conclusions: As peripheral neuropathy is a common HIV-associated neurologic complication, large number of studies are needed to elucidate the mechanisms leading to peripheral neuropathy in HIV infected patients, which in turn will allow for the development of effective therapies that provide adequate symptomatic relief and halt or reverse the damage to the nerves

Circulating Folate Concentrations and Risk of Peripheral Neuropathy and Mortality: A Retrospective Cohort Study in the U.K

BACKGROUND: Folate deficiency may increase the risk of peripheral neuropathy but there is a paucity of data from large prospective studies examining this association. METHODS: Longitudinal analysis of electronic health records in The Health Improvement Network (THIN), a U.K. primary care database including 594,338 patients aged 18-70 years with a folate measurement and without a history of peripheral neuropathy. RESULTS: After a mean follow-up of 3.71 (standard deviation (SD) = 3.14) years, 1949 patients were diagnosed with peripheral neuropathy and 20,679 patients died. In those <40 years, compared to patients with folate ≥13.6 nmol/L, those with folate <6.8 (deficient) and 6.8-13.5 nmol/L (insufficient) had a hazard ratio (HR) for peripheral neuropathy of 1.83 (95% confidence intervals (CI) = 1.16-2.91) and 1.48 (95% CI = 1.04-2.08), respectively. There was no significant association between folate and peripheral neuropathy among those aged 41-70 years. Compared to patients with folate ≥ 13.6 nmol/L, folate <6.8 nmol/L was associated with a greater risk of death among all ages. CONCLUSION: Folate deficiency and insufficiency was associated with a greater risk of peripheral neuropathy among younger patients. This investigation should be replicated in other large datasets and it may be important to monitor peripheral neuropathy incidence after the introduction of mandatory folic acid fortification of flour in the U.K

Peripheral Neuropathy

Understanding the rapid changes in the evaluation and management of peripheral neuropathies, as well as the complexity of their mechanism, is a mandatory requirement for the practitioner to optimize patient's care. The objective of this book is to update health care professionals on recent advances in the pathogenesis, diagnosis and treatment of peripheral neuropathy. This work was written by a group of clinicians and scientists with large expertise in the field

Peripheral Neuropathy

Over the last two decades we have seen extensive progress within the practice of neurology. We have refined our understanding of the etiology and pathogenesis for both peripheral and central nervous system diseases, and developed new therapeutic approaches towards these diseases. Peripheral neuropathy is a common disorder seen by many specialists and can pose a diagnostic dilemma. Many etiologies, including drugs that are used to treat other diseases, can cause peripheral neuropathy. However, the most common cause is Diabetes Mellitus, a disease all physicians encounter. Disability due to peripheral neuropathy can be severe, as the patients suffer from symptoms daily. This book addresses the advances in the diagnosis and therapies of peripheral neuropathy over the last decade. The basics of different peripheral neuropathies is briefly discussed, however, the book focuses on topics that address new approaches to peripheral neuropathies

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

ObjectiveTo determine the associations between individual metabolic syndrome (MetS) components and peripheral neuropathy in a large populationâ based cohort from Pinggu, China.MethodsA crossâ sectional, randomly selected, populationâ based survey of participants from Pinggu, China was performed. Metabolic phenotyping and neuropathy outcomes were performed by trained personnel. Glycemic status was defined according to the American Diabetes Association criteria, and the MetS using modified consensus criteria (body mass index instead of waist circumference). The primary peripheral neuropathy outcome was the Michigan Neuropathy Screening Instrument (MNSI) examination. Secondary outcomes were the MNSI questionnaire and monofilament testing. Multivariable models were used to assess for associations between individual MetS components and peripheral neuropathy. Treeâ based methods were used to construct a classifier for peripheral neuropathy using demographics and MetS components.ResultsThe mean (SD) age of the 4002 participants was 51.6 (11.8) and 51.0% were male; 37.2% of the population had normoglycemia, 44.0% prediabetes, and 18.9% diabetes. The prevalence of peripheral neuropathy increased with worsening glycemic status (3.25% in normoglycemia, 6.29% in prediabetes, and 15.12% in diabetes, P < 0.0001). Diabetes (odds ratio [OR] 2.60, 95% CI 1.77â 3.80) and weight (OR 1.09, 95% CI 1.02â 1.18) were significantly associated with peripheral neuropathy. Age, diabetes, and weight were the primary splitters in the classification tree for peripheral neuropathy.InterpretationSimilar to previous studies, diabetes and obesity are the main metabolic drivers of peripheral neuropathy. The consistency of these results reinforces the urgent need for effective interventions that target these metabolic factors to prevent and/or treat peripheral neuropathy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143679/1/acn3531_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143679/2/acn3531.pd

Frequency of peripheral neuropathy in newly diagnosed patients of diabetes mellitus iion clinical and electrophysiological basis

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to female was . 1.14The age group distribution of study population ranged from 30-60 years and mean age was 45.19 with standard deviation of 7.38. It was observed that 35 (32.7%) patients had symptoms of peripheral neuropathy as compared to this 72 (67.3.2%) patients did not have symptoms of peripheral neuropathy while mean ± standard deviation of duration of symptoms was 2.42±1.95 months and 18 (16.8%) patients had peripheral neuropathy as compared to these 89 (83.2%) patients did not have peripheral neuropathy, clinical or electrophysiological. Conclusion: Diabetic Peripheral Neuropathy is a fairly common entity in our patients with type 2 Diabetes Mellitus and was seen as early as within four weeks of diagnosis in 16.8% of patients