Abstract
Background. Since 2008, we have observed an increasing number of Myanmarese refugees in Malaysia being admitted for acute/subacute onset peripheral neuropathy. Most of them had a preceding history of starvation. Methods. We retrospectively studied the clinical features of all Myanmarese patients admitted with peripheral neuropathy from September 2008 to January 2014. Results. A total of 24 patients from the Chin, Rohingya, and Rakhine ethnicities (mean age, 23.8 years; male, 96%) had symmetrical, ascending areflexic weakness with at least one additional presenting symptom of fever, lower limb swelling, vomiting, abdominal pain, or difficulty in breathing. Twenty (83.3%) had sensory symptoms. Ten (41.6%) had cranial nerve involvement. Nineteen patients had cerebrospinal fluid examinations but none with evidence of albuminocytological dissociation. Neurophysiological assessment revealed axonal polyneuropathy, predominantly a motor-sensory subtype. Folate and vitamin B12 deficiencies were detected in 31.5% of them. These findings suggested the presence of a polyneuropathy related to nutrition against a backdrop of other possible environmental factors such as infections, metabolic disorders, or exposure to unknown toxin. Supportive treatment with appropriate vitamins supplementation improved functional outcome in most patients. Conclusion. We report a spectrum of acquired reversible neurological manifestations among Myanmarese refugees likely to be multifactorial with micronutrient deficiencies playing an important role in the pathogenesis.
Highlights
In Malaysia, where many Myanmarese people have been seeking refuge under the shelter of UNHCR, we observed over the past 6 years an increasing number of these refugees admitted with acute peripheral neuropathy
Electrophysiology studies showed axonal polyneuropathy and cerebrospinal fluid (CSF) analysis was usually acellular with normal protein levels
Most were treated with various vitamin supplementations while some were given immunotherapy, for example, intravenous immunoglobulin infusion, despite lack of clinical and biochemical evidence of immune-mediated cause of peripheral neuropathy (Table 6)
Summary
In Malaysia, where many Myanmarese people have been seeking refuge under the shelter of UNHCR, we observed over the past 6 years an increasing number of these refugees admitted with acute peripheral neuropathy. Most of the patients appeared malnourished with a preceding history of starvation of two to four weeks before onset of symptoms. These neuropathies manifested as acute to subacute onset, ascending, areflexic paralysis, with some having sensory and cranial nerve involvement. Since 2008, we have observed an increasing number of Myanmarese refugees in Malaysia being admitted for acute/subacute onset peripheral neuropathy. We retrospectively studied the clinical features of all Myanmarese patients admitted with peripheral neuropathy from September 2008 to January 2014. We report a spectrum of acquired reversible neurological manifestations among Myanmarese refugees likely to be multifactorial with micronutrient deficiencies playing an important role in the pathogenesis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
