Course Of Polyneuropathy Research Articles

Longitudinal evaluation of polyneuropathy in Parkinson’s disease

BackgroundIncreasing evidence indicates a higher prevalence of polyneuropathy (PNP) in Parkinson’s disease (PD). However, the involvement of large fiber neuropathy in PD still remains poorly understood. Given the lack of longitudinal data, we investigated the course of PNP associated with PD.MethodsIn total, 41 PD patients underwent comprehensive clinical evaluation including motor and non-motor assessments as well as nerve conduction studies at baseline and at 2 years of follow-up. The definition of PNP was based on electrophysiological standard criteria. Common causes of PNP were excluded.ResultsAt baseline, PNP was diagnosed in 65.85% of PD patients via electroneurography. Patients with PNP presented with higher age (p = 0.019) and PD motor symptom severity (UPDRS III; p < 0.001). Over the course of 2 years, PNP deteriorated in 21.95% of cases, and 26.83% remained without PNP. Deterioration of nerve amplitude was most prevalent in the median sensory nerve affecting 57.58% of all PD cases with an overall reduction of median sensory nerve amplitude of 45.0%. With regard to PD phenotype, PNP progression was observed in 33.33% of the tremor dominant and 23.81% of the postural instability/gait difficulties subtype. Decrease of sural nerve amplitude correlated with lower quality of life (PDQ-39, p = 0.037) and worse cognitive status at baseline (MoCA, p = 0.042).ConclusionThe study confirms the high PNP rate in PD, and demonstrates a significant electrophysiological progression also involving nerves of the upper extremities. Longitudinal studies with larger cohorts are urgently needed and should elucidate the link between PD and PNP with the underlying pathomechanisms.

Long-term effects of pancreatic islet transplantation on polyneuropathy in patients with brittle diabetes: A single-center experience.

Pancreatic islet transplantation (ITx) is increasingly used in patients with brittle type 1 diabetes (T1D). If successful, ITx results in insulin-free euglycemia, but its application is limited by a need for lifelong immunosuppression. The aim of this study was to assess the long-term effects of ITx on the occurrence and course of polyneuropathy in a cohort of patients with brittle T1D. In this prospective, single-center study, 13 patients (4 males and 9 females) with brittle T1D had a baseline neurological exam with the calculation of Utah Neuropathy Scale (UNS) and a limited nerve conduction study before ITx, and about yearly after in the patients who achieved insulin independence. Patients were followed for a period of 17 to 133 months. There was no significant difference between UNS and nerve conduction study parameters at baseline and at the end of follow-up, except for significant decreases in peroneal (50.34 ± 6.12 vs. 52.42 ± 6.47 ms, P = 0.005) and ulnar (27.5 ± 2.15 vs. 29.45 ± 2.10 ms, P = 0.009) F-wave latencies and an increase in ulnar sensory nerve conduction velocity (49.98 ± 6.27 vs. 47.19 ± 5.36 m/s, P = 0.04). If successful, ITx has a good long-term safety profile for peripheral nerve toxicity, and a favorable effect on diabetic neuropathy.

The effect of ischemic preconditioning on the course of polyneuropathy in vibration disease

One of the primary syndromes of vibration disease is polyneuropathy, which is characterized primarily by the involvement of sensory fibers. In the clinical picture, such a lesion manifests itself in the form of sensitive disorders (pain, numbness, paresthesia), which worsen patients' quality of life. The neuroprotective effect of ischemic preconditioning is currently insufficiently studied and is a promising area of scientific research. The study aims to learn the effect of ischemic preconditioning of the upper extremities on the clinical and neurophysiological manifestations of polyneuropathic lesion in vibration disease. Scientists examined 70 patients with an established diagnosis of vibration disease (40 people - the leading group and underwent ischemic preconditioning of the upper extremities, 30 people - the control group, they did not use this technique. All subjects underwent clinical and electroneuromyographic examinations before ischemic preconditioning on the 5th day of the study. The initial indicators of the examination in both groups did not differ statistically and had signs of the polyneuropathic lesion. However, after ischemic preconditioning, clinical symptoms significantly decreased, the speed of conduction along sensory fibers increased, but we did not find significant objectivity of dynamics in the control group. Ischemic preconditioning of the upper extremities in vibration disease leads to a decrease in the severity of the clinical and neurophysiological picture of the polyneuropathic lesion.

The effect of ischemic preconditioning on the course of polyneuropathy in vibration disease

One of the primary syndromes of vibration disease is polyneuropathy, which is characterized primarily by the involvement of sensory fibers. In the clinical picture, such a lesion manifests itself in the form of sensitive disorders (pain, numbness, paresthesia), which worsen patients' quality of life. The neuroprotective effect of ischemic preconditioning is currently insufficiently studied and is a promising area of scientific research. The study aims to learn the effect of ischemic preconditioning of the upper extremities on the clinical and neurophysiological manifestations of polyneuropathic lesion in vibration disease. Scientists examined 70 patients with an established diagnosis of vibration disease (40 people - the leading group and underwent ischemic preconditioning of the upper extremities, 30 people - the control group, they did not use this technique. All subjects underwent clinical and electroneuromyographic examinations before ischemic preconditioning on the 5th day of the study. The initial indicators of the examination in both groups did not differ statistically and had signs of the polyneuropathic lesion. However, after ischemic preconditioning, clinical symptoms significantly decreased, the speed of conduction along sensory fibers increased, but we did not find significant objectivity of dynamics in the control group. Ischemic preconditioning of the upper extremities in vibration disease leads to a decrease in the severity of the clinical and neurophysiological picture of the polyneuropathic lesion.

Diyabetes mellitusta iyi glisemik kontrol ile nöropati gelişimi önlenebilir mi?

Objective: In our study, we aimed to investigate the effect of insulin treatment on peripheral nerves in patients with diabetes mellitus (DM) who under the oral antidiabetic therapy changed to insulin treatment. Additionally, we have searched for answer to the question that could F response used for as a parameter on monitoring the course of polyneuropathy with glycemic control. F response which use in the detection of polyneuropathy has been emphasized in previous studies. Material and Method: Ten voluntary diabetic patients who received indication insulin treatment while being monitored with oral antidiabetic treatment and diagnosed according to the American Diabetes Association (ADA) criteria were included in our study. All our patients were outpatients of Sisli Etfal Training and Research Hospital Diabetes Mellitus Clinic. All patients were evaluated for neurological examination, serum glucose and HbA1c levels, total neuropathy score (TNS) and electrophysiological evaluations before insulin treatment and in the first and fourth week of the treatment. Results: Seven of patients were women and three of them were men. Age of patients were ranged from 40 to 69 and the mean age was 55±9.01. DM duration of patients ranged from 1 to 15 years (mean: 6.2±4.83). On the first Electrophysiologic evaluations of four patients were assessed within normal limits. We detected sensory polyneuropathy in lower extremities in five patients and a polyneuropathy syndrome which affecting sensory fibers in the upper extremity and both sensory and motor fibers in the lower extremities in the remaining patient. We observed particularly improvement the sensory conduction amplitude in the control electrophysiological evaluation of the patients with moderate neuropathy or without polyneuropathy but there was not a significant difference in control electrophysiological evaluation of the patients with severe polyneuropathy in the initial evaluation. Conclusion: After occurring severe polineuropathy syndrome there is not any improvement with good glicemic control whereas early stage of polyneuropathy.

Prognosis of polyneuropathy due to IgM monoclonal gammopathy

The disease course of polyneuropathy associated with immunoglobulin M monoclonal gammopathy (IgM MGUSP) can be highly variable. In order to identify factors that influence long-term disease outcome, a prospective cohort study was performed of 140 patients with IgM MGUSP over a period of 23 years. All patients with IgM MGUSP who were diagnosed in our tertiary referral center for polyneuropathy were eligible. All patients underwent nerve conduction studies and were tested for anti-MAG antibodies. The modified Rankin Scale, graded muscle strength, quantified sensory function, and laboratory testing were performed at 0, 1, 2, and 5 years and at last visit. The primary outcome measure was the risk of developing a modified Rankin Scale score of > or = 3 points. A total of 140 patients with IgM MGUSP fulfilled inclusion criteria (101 [72%] demyelinating, 39 [28%] axonal, 63 [44%] MAG positive). The median age at onset was 59 years (interquartile range 52-67), median disease duration at baseline was 3.2 years (interquartile range 1.9-6). Anti-MAG antibodies were associated with a lower risk of Rankin Scale score > or = 3. Demyelination and a higher age at onset were associated with a higher risk for Rankin Scale score > or = 3. Based on these 3 factors, a Web-based prognostic model was developed that directly allows clinicians to estimate the probability of developing disability (http://www.umcutrecht.nl/subsite/Prognosis-MGUS-Neuropathy). Higher age at onset and demyelination increase the risk, whereas anti-MAG antibodies decrease the risk, of developing Rankin Scale score > or = 3 in polyneuropathy associated with immunoglobulin M monoclonal gammopathy (IgM MGUSP). Our Web-based prognostic model allows determination of prognosis in IgM MGUSP.

Methods for assessing diabetic polyneuropathy: validity and reproducibility of the measurement of sensory symptom severity and nerve function tests

The usefulness of sensory symptoms in the assessment of diabetic polyneuropathy is unclear. In the present study, we studied the hypothesis that pain is associated with small nerve fibre function, and that sensory alteration is associated with large nerve fibre function. In addition, we assessed the reproducibility and the ability to detect changes in clinical status over time of the nerve function tests currently used in clinical trials. Patients (78) with stable diabetic polyneuropathy were examined on three separate occasions with a test–retest interval of 17 and 52 weeks. Small nerve fibre function was measured using temperature discrimination thresholds for warmth (TDT warmth) and cold (TDT cold). Large nerve fibre function was measured by testing sensory and motor nerve conduction velocities (SNCV and MNCV) and vibration perception thresholds (VPT). Neuropathic pain was only significantly associated with TDT cold, and with the MNCV of the tibial nerve. Sensory alteration was associated with almost all nerve function tests except the SNCV and MNCV of the ulnar nerve. The measurements of symptom severity and the nerve function tests all proved to be sufficiently reproducible. The standardized smallest detectable difference on group level (SDD) of the measurement of sensory alteration and neuropathic pain were almost the same (9% and 12%, respectively). Among the nerve function tests, the SNCV and MNCV had the smallest SDD (3–4%), and were, therefore, potentially the most responsive instruments. The SDD of the TDT was greater than the VPT (9–14% vs 21–28%, respectively). In conclusion, neuropathic pain was not associated with small nerve fibre function, and sensory alteration was associated with both large and small fibre function. In addition, the standardized measurement of symptom severity, the SNCV and MNCV tests, and the VPT test appear to be useful for monitoring the course of polyneuropathy in clinical trials.

Polyneuropathy associated with monoclonal gammopathy of undetermined significance. A prospective study of the prognostic value of clinical and laboratory abnormalities.

The natural course of polyneuropathy associated with monoclonal gammopathy of undetermined significance (MGUS) is not well known. We therefore studied 32 untreated patients for a period of 5 years. Fifteen patients had an IgM M-protein, 15 an IgG and two an IgA. There was a male predominance, a mean age of onset at the end of the sixth decade and sensory signs were more pronounced than motor deficits. On entry into the study and during the 5 years of follow-up, we quantified the neuropathy in a standard way: totals of motor and sensory scores; vibration perception threshold; tapping tests; quantified Romberg test; electrophysiological parameters. A significant difference in the natural history between the polyneuropathy associated with IgM-MGUS and IgG/IgA-MGUS was found for the motor and sensory sum scores, the vibration perception threshold and the tapping tests. The polyneuropathy in IgM-MGUS is more progressive, with significantly more weakness and sensory signs, indicating that the neuropathies associated with IgM-MGUS and IgG/A-MGUS may be two different entities. A rapid progression of the neuropathy was found in five patients. We found no predictive factors for this severe progression of the neuropathy of these five patients. Of these five, three (two IgM, one IgG) developed a non-Hodgkin lymphoma.