Abstract
Neurologic complications of bariatric surgery have become increasingly recognized with the rising numbers of procedures and the increasing prevalence of obesity in the US. Deficits are most commonly seen with thiamine, vitamin B12, folate, vitamin D, vitamin E, and copper deficiencies. The neurological findings observed with these nutritional deficiencies are variable and include encephalopathy, optic neuropathy, myelopathy, polyradiculoneuropathy, and polyneuropathy. We review the neurological complications of bariatric surgery and emphasize that these findings may vary based on the specific type of bariatric surgery and time elapsed from the procedure.
Highlights
The rate of obesity continues to rise and affects more than one-third of the US adult population [1]
Up to 40% of patients presenting with neurologic complications develop encephalopathy, many of whom are deficient in thiamine [3, 8]
Myelopathy in the setting of nutritional deficiency is commonly seen and frequently can be one of the most debilitating problems associated with bariatric surgery
Summary
The rate of obesity continues to rise and affects more than one-third of the US adult population (over 72 million people) [1]. As the prevalence of obesity and the numbers of patients undergoing bariatric surgeries rise, the incidence and recognition of neurologic complications from bariatric surgery continues to increase. The procedures that are restrictive and produce malabsorption include the Roux-en-Y gastric bypass procedure and the biliopancreatic diversion with duodenal switch After these surgeries, patients should remain on high protein and low-fat diets with vitamin supplementation and have nutritional and metabolic blood tests performed on a frequent basis. Roux-en-Y 5,000–10,000 IU/d Acute:100 mg/d × 7–14 d (IM) 10 mg/d (oral) Prophylaxis: 50–100 mg/d 300–500 μg/d (oral) 1000 mg/q 3 months (IM) 400 μg/d 65 mg/twice daily 1,500–2,000 mg/d 800–1,200 IU/d Supplement with standard multivitamin formulation rich in vitamin E (60 IU/d) Supplementation may be required, monitor Oral (1 mg/d) or IV fusion, response variable. The standard recommendation for daily oral supplementation after surgery in asymptomatic patients is 50–100 mg/d (Table 2) [4,5,6, 9, 10]
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