Peripheral Nervous System In Patients Research Articles

PATHOGENESIS OF AUTONOMIC AND PERIPHERAL NEUROPATHY IN PATIENTS WITH PSORIASIS

There is enough data confirming the common mechanisms of damage to the nervous system and skin in psoriasis. Cardiac autonomic denervation is a mechanism of cardiovascular pathology in psoriasis. Thus, a simultaneous disturbance of sympathetic and parasympathetic impact on vascular tone and heart rhythm has been established. When performing an active orthotest in trial subjects, heart rate centralization and decreased autonomous circuit activity were found. In psoriasis, vegetative-vascular dystonia develops due to metabolic disorders that occur in diabetes mellitus. Inflammatory cytokines Th-1, adhesion molecules, and angiogenic factors are involved in pathological processes in obesity, diabetes, metabolic syndrome, and thrombotic complications. Microangiopathy, which develops in psoriasis, reduces the response of blood vessels to autonomic innervation. Such negative influences eventually lead to a persistent alteration of the autonomic nervous control. The authors resent the results of a few studies on the peripheral nervous system in patients with psoriasis. There is evidence of a symmetrical alteration of vibration, tactile, pain and temperature sensitivity in the distal regions of all four limbs. There are some histological studies of the sural nerve in patients with psoriasis, which indicate demyelination of nerve fibers. In this regard, the study of neuropathy pathogenesis in psoriasis is necessary to improve the disease course and the effectiveness of psoriasis therapy.
 Assessment of psoriatic lesion severity and timely detection of cardiac denervation will reduce the risk of fatal cardiovascular complications. Instrumental diagnostics of the peripheral nervous system will make it possible to differentiate damage to muscle and nerve fibers in psoriasis.

Consequences of COVID-19 for the musculoskeletal and peripheral nervous systems. Diagnosis of complications (literature review)

COVID-19 disease does not only lead to impaired respiratory function. Post-COVID complications are multiple with the involvement of many body systems, including the musculoskeletal system and the peripheral nervous system. Diseases of the musculoskeletal system include myalgia, myositis, rhabdomyolysis, acute arthralgia, arthritis, bone osteoporosis. Damage to the peripheral nervous system caused by coronavirus infection includes plexopathy due to lying down, poly-neuropathy, GuillainBarre syndrome. This descriptive literature review discusses the effects of COVID-19 on the musculoskeletal system and the peripheral nervous system of patients. Data are presented on the use of diagnostic tools such as computed tomography, magnetic resonance imaging, and ultrasound scans to detect pathology.

Neurophysiological Aspects in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome.

Patients with coronavirus disease 2019 (COVID-19) often develop acute respiratory failure and acute respiratory distress syndrome (ARDS) that requires intensive care unit (ICU) hospitalization and invasive mechanical ventilation, associated with a high mortality rate. In addition, many patients fail early weaning attempts, further increasing ICU length of stay and mortality. COVID-19 related ARDS can be complicated by neurological involvement with mechanisms of direct central nervous system (CNS) infection and with overlapping para-infective mechanisms of the peripheral nervous system (PNS). We aimed to evaluate the possible involvement of the brainstem and PNS in patients with COVID-19 related ARDS and difficulty in weaning from mechanical ventilation. We evaluated electroencephalogram (EEG), brainstem auditory evoked potentials (BAEPs), electroneurography of the four limbs and the phrenic nerve in 10 patients with respiratory insufficiency due to SARS-CoV-2. All were admitted to intensive care unit and were facing prolonged weaning from mechanical ventilation. All ten patients showed a mild diffuse non-specific slowing of brain electrical activity on the EEG. Four patients had an acute motor axonal neuropathy with absent or reduced amplitude phrenic nerve CMAP while four patients showed impairment of the BAEPs. A patient with peripheral nerve impairment suggestive of Guillain-Barré syndrome (GBS) underwent an intravenous immunoglobulin (IVIg) cycle that led to an improvement in the weaning process and progressive motor improvement. The inclusion of a comprehensive neurological evaluation in COVID-19 patients in ICU facilitated the early identification and effective management of Nervous System involvement.

Phosphorylated TDP-43 aggregates in peripheral motor nerves of patients with amyotrophic lateral sclerosis.

Phosphorylated TDP-43 (pTDP-43) aggregates in the cytoplasm of motor neurons and neuroglia in the brain are one of the pathological hallmarks of amyotrophic lateral sclerosis. Although the axons exceed the total volume of motor neuron soma by several orders of magnitude, systematic studies investigating the presence and distribution of pTDP-43 aggregates within motor nerves are still lacking. The aim of this study is to define the TDP-43/pTDP-43 pathology in diagnostic motor nerve biopsies performed on a large cohort of patients presenting with a lower motor neuron syndrome and to assess whether this might be a discriminating tissue biomarker for amyotrophic lateral sclerosis and non-amyotrophic lateral sclerosis cases.We retrospectively evaluated 102 lower motor neuron syndrome patients referred to our centre for a diagnostic motor nerve biopsy. Histopathological criteria of motor neuron disease and motor neuropathy were applied by two independent evaluators, who were blind to clinical data. TDP-43 and pTDP-43 were evaluated by immunohistochemistry, and results compared to final clinical diagnosis.We detected significant differences between amyotrophic lateral sclerosis and non-amyotrophic lateral sclerosis cases in pTDP-43 expression in myelinated fibres: axonal accumulation was detected in 98.2% of patients with amyotrophic lateral sclerosis versus 30.4% of non-amyotrophic lateral sclerosis samples (P < 0.0001), while concomitant positive staining in Schwan cell cytoplasm was found in 70.2% of patients with amyotrophic lateral sclerosis versus 17.4% of patients who did not have amyotrophic lateral sclerosis (P < 0.001). Importantly, we were also able to detect pTDP-43 aggregates in amyotrophic lateral sclerosis cases displaying normal features at standard histopathological analysis.Our findings demonstrated that a specific pTDP-43 signature is present in the peripheral nervous system of patients with amyotrophic lateral sclerosis, and could be exploited as a specific, accessible tissue biomarker. The detection of pTDP-43 aggregates within motor nerves of living patients with amyotrophic lateral sclerosis, occurring before axonal degeneration, suggests that this is an early event that may contribute to amyotrophic lateral sclerosis pathogenesis.

Neurophysiological biomarkers of peripheral nervous system affection in patients with stable chronic obstructive pulmonary disease (COPD)

BackgroundChronic obstructive pulmonary disease (COPD) is accompanied by substantial systemic dysregulations that comprise systemic inflammation and neurohormonal activation in addition to many neurological involvements, such as cerebrovascular diseases, polyneuropathies, motor neuron diseases, and cognitive impairment has been described in COPD patients. The aim of the current work was to detect the subclinical affection of the peripheral nervous system in patients with stable COPD.ResultsForty COPD patients and 30 subjects as healthy control were enrolled. All included subjects were submitted to complete medical history, clinical evaluations, investigations in the form of; arterial blood gases, spirometry, in addition to nerve conduction study. The patients with COPD were classified according to GOLD criteria for severity in grade I in 7.5% grade II in 62.5%, grade III in 20%, and grade IV in 10%. The results show a statistically significant increase in distal latency and a statistically significant decrease of amplitude and conduction velocity in patients with COPD when compared to the examined nerves of control group. The demyelinating nerve affection was the most common.ConclusionIn COPD patients the peripheral nervous system could be affected subclinically once the severity of COPD increased and the patient should be neurophysiologically observed for early recognition of peripheral nervous system affection.

Iron Dysregulation and Inflammagens Related to Oral and Gut Health Are Central to the Development of Parkinson's Disease.

Neuronal lesions in Parkinson’s disease (PD) are commonly associated with α-synuclein (α-Syn)-induced cell damage that are present both in the central and peripheral nervous systems of patients, with the enteric nervous system also being especially vulnerable. Here, we bring together evidence that the development and presence of PD depends on specific sets of interlinking factors that include neuroinflammation, systemic inflammation, α-Syn-induced cell damage, vascular dysfunction, iron dysregulation, and gut and periodontal dysbiosis. We argue that there is significant evidence that bacterial inflammagens fuel this systemic inflammation, and might be central to the development of PD. We also discuss the processes whereby bacterial inflammagens may be involved in causing nucleation of proteins, including of α-Syn. Lastly, we review evidence that iron chelation, pre-and probiotics, as well as antibiotics and faecal transplant treatment might be valuable treatments in PD. A most important consideration, however, is that these therapeutic options need to be validated and tested in randomized controlled clinical trials. However, targeting underlying mechanisms of PD, including gut dysbiosis and iron toxicity, have potentially opened up possibilities of a wide variety of novel treatments, which may relieve the characteristic motor and nonmotor deficits of PD, and may even slow the progression and/or accompanying gut-related conditions of the disease.

Neurological Outcome and Quality of Life Three Months after COVID-19: A Prospective Observational Cohort Study

BACKGROUND: Increasing evidence suggests the involvement of the central and peripheral nervous system in patients with coronavirus disease 2019 (COVID-19). Little is known about neurological outcomes and quality of life (QoL) after recovery from acute infection.METHODS: In this prospective, multicentre, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin-Sticks-test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist-5) three months after disease onset.FINDINGS: Of 135 COVID-19 patients included, 31 (23%) required ICU-care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient-care (mild) during acute disease. At three-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included poly-neuro/myopathy (n=16, 12%), mild encephalopathy (n=2, 2%), parkinsonism (n=1, 1%), orthostatic hypotension (n=1, 1%), Guillain-Barré-Syndrome (n=1, 1%) and ischemic stroke (n=1, 1%). Self-reported hyposmia/anosmia was noted in 23/135 patients (17%), which was significantly lower compared to those documented during acute COVID-19 (44%; pINTERPRETATION: Despite recovery from acute infection, neurological symptoms were prevalent at three-months follow-up. Above all, smelling disorders were persistent in a large proportion of patients. Our results urge for further studies investigating the onset and evolution of neurological diseases following COVID-19 infection to develop strategies for secondary prevention.TRIAL REGISTRATION: ClinicalTrials.gov (NCT04416100)FUNDING: Not applicable.DECLARATION OF INTERESTS: KS reports grants from FWF Austrian Science Fund, grants from Michael J. Fox Foundation, grants from International Parkinson and Movement Disorder Society, personal fees from Teva, personal fees from UCB, personal fees from Lundbeck, personal fees from AOP Orphan Pharmaceuticals AG, personal fees from Abbvie, personal fees from Roche, personal fees from Grünenthal; all outside the submitted work. PM reports grants from TWF (Tyrolean Science Fund), grants from Medtronic, personal fees from Boston Scientific, all outside the submitted work. The other authors have nothing to disclose. All other authors declare no competing interests.ETHICS APPROVAL STATEMENT: The conduct of the study was approved by the local ethics committee (Medical University of Innsbruck, EK Nr: 1103/2020). Written informed consent was obtained from all patients according to local regulations.

Análisis clínico y electrofisiológico del hipotiroidismo subclínico en una población hospitalaria

Objetivo: Investigar los efectos del hipotiroidismo primario subclínico y clínico en la función nerviosa periférica. Métodos: Estudio prospectivo de pacientes seleccionados con diagnóstico de hipotiroidismo primario subclínico y clínico con sintomatología sensitiva o motora; se analizaron variables demográficas, tipo de hipotiroidismo, tratamiento con levotiroxina (LT4); se definió la presencia de polineuropatía o neuropatía focal con estudios de velocidad de conducción nerviosa. Resultados: Se estudiaron a 33 pacientes con diagnóstico de hipotiroidismo clínico (HC) y subclínico (HSC), el promedio de edad fue de 64.76 años, el 90.9 % de los pacientes fueron del sexo femenino, el dolor y las parestesias de las extremidades fueron la sintomatologías más frecuentes, en el HC los niveles de TSH y T4 Libre fueron normales, en el HSC los niveles promedio de TSH y T4 libre fueron de: 11.40 mU/L y 0.85 ng/dl respectivamente. Al realizar las pruebas neurofisiológicas se observó que el 42.4 % de los pacientes en general, tuvieron alteraciones en los estudios de neuro conducción sensitiva o motora. Conclusiones: Existe un número limitado de estudios funcionales a nivel del Sistema Nervioso Periférico en pacientes con este trastorno, la afectación del nervio periférico en el hipotiroidismo probablemente esté relacionado a la duración de la enfermedad e influenciados por el tratamiento específico.

Evaluation of the Effects of Insulin Therapy on peripheral Nervous System in Diabetic Patients

Peripheral neuropathy is common diabetic complication that associated with high rates of morbidity and mortality. Insulin therapy is essential in treatment of diabetic peripheral neuropathy; however, rapid strict glycemic control may lead to many complications such as neuropathy. This study performed to evaluate the effect of insulin therapy on peripheral nervous system in patients with type 2 diabetes. This study was conducted in outpatient clinics of Neurology departments of “Azadi Teaching Hospital in Kirkuk city-Iraq” during the period from the 1st of October, 2015 to 30th of September, 2017 included 50 type 2 diabetic patients treated with insulin therapy. Patients followed up at 3rd and 6th months after first examination by evaluating fasting blood sugar, hemoglobin A1c, Toronto scoring and nerve conduction study. Findings revealed predominance of females. There was a significant decline in overnight fasting blood sugar and hemoglobin A1c levels after 6 months follow up (p<0.001). The mean Toronto score increased from 5.9 at baseline to 10.6 after 3 months and 12.1 after 6 months. In conclusion the rapid strict glycemic control of blood sugar level is obviously considered to be a risk factor for peripheral neuropathy development among type 2 diabetic patients.

FEATURES OF THE PERIPHERAL NERVOUS SYSTEM AFFECTION IN PATIENTS WITH PRIMARY HYPOTHYROIDISM

Objective. The purpose of the work is to identify the clinical features of the peripheral nervous system in patients with subclinical and clinically expressed hypothyroidism against the background of autoimmune thyroiditis and postoperative hypothyroidism.Materials and methods. The study involved 56 patients with hypothyroidism as a result of AIT (autoimmune thyroiditis) and 20 patients with postoperative hypothyroidism. 18 patients had subclinical hypothyroidism. We used clinical-neurological and electrophysiological examination of patients.Results. The affection of the peripheral nervous system manifested itself by sensitive polyneuropathy (86,8%) in combination with tunnel neuropathies (62,5%), and supplemented by myotonic phenomenon (21,1%) and myopathic syndrome (18,4%). In patients with autoimmune thyroiditis with thyroid hypofunction, polyneuropathy and tunnel neuropathies were prevalent. In patients with postoperative hypothyroidism, myopathic changes predominated.Conclusion. Sensory polyneuropathy and multiple tunnel syndromes, especially in combination with mild myopathic syndrome suggests hypothyroidism in the thyroid gland and determines the need for further endocrinological examination for justification of differentiated tactics for the management of these patients.

Peripheral nervous system involvement in systemic lupus erythematosus: Prevalence, clinical and immunological characteristics, treatment and outcome of a large cohort from a single centre.

Disorders of peripheral nervous system in patients with systemic lupus erythematosus (PNS-SLE) are a major cause of morbidity. The aims of the present study were to determine the prevalence of PNS-SLE involvement in a large cohort of SLE patients from a single centre, to characterize such involvement, treatment modalities and outcome, and to identify the possible variables that may be associated with its presence. We performed an observational cross-sectional study that included all SLE patients being followed in our department between March and December 2015 who met at least one of the PNS-SLE case definitions proposed in 1999 by the American College of Rheumatology. Overall, 93 out of 524 (17,7%) patients presented with PNS-SLE syndrome; 90 (96.8%) of them were women with a mean age at PNS-SLE syndrome diagnosis was 44.8±14.1years and the average time from diagnosis of SLE to PNS-SLE diagnosis was 88 (range, 541-400) months. The most frequent manifestation was polyneuropathy (36.6%), followed by non-compression mononeuropathy (23.7%), cranial neuropathy and myasthenia gravis (7.5%, each), and Guillain-Barré syndrome (1.1%). The most frequent electrodiagnostic tests (EDX) pattern was axonal degeneration, present in 49 patients that corresponded to 80.3% of the overall EDX patterns. Mixed sensory-motor neuropathy was the most common type of involvement accounted for 56% of cases. Thirty-six out of 90 (40%) received glucocorticoids and/or immunosuppressant agents. Overall, global response (complete and/or partial) to treatments was achieved in 77.4% of patients without differences between the types of PNS-SLE involvement. Older age at SLE diagnosis (37.3±14.8 versus 30.8±12; p=0.001) and absence of hematologic involvement as cumulative SLE manifestation (11.8% versus 21.5%; p=0.034) had independent statistical significant associations with PNS-SLE development. The PNS-SLE involvement is not uncommon. Its most frequent manifestation is sensory-motor axonal polyneuropathy. The involvement occurs more frequently in patients who are diagnosed with SLE at older age. Prospective studies are needed to establish the incidence of PNS-SLE syndromes and the role of hematological manifestations in their development.

The Search for a Peripheral Biopsy Indicator of α-Synuclein Pathology for Parkinson Disease.

The neuropathological hallmark of Parkinson disease (PD) is abnormal accumulation of α-synuclein (α-syn). Demonstrating pathological α-syn in live patients would be useful for identifying and monitoring PD patients. To date, however, imaging and biofluid approaches have not permitted premortem assessment of pathological α-syn. α-syn pathology in the peripheral nervous system of patients with PD has been demonstrated in studies dating back more than 40 years. More recent work suggests that colon, submandibular gland and skin biopsies could be useful as expedient biomarkers but histological differentiation of pathological and normal peripheral α-syn has been challenging and multiple research groups have reported variable results. A variety of immunohistochemical methods have been employed but almost all studies to date originated at single centers with no independent, blinded replication. To address these issues, the Michael J. Fox Foundation for Parkinson's Research sponsored a series of meetings and investigations by several research groups with relevant experience. The major finding reported herein was that biopsies can be used to distinguish PD patients from normal subjects. However, full assessment of the clinical potential of biopsy will only be achieved through large, multicenter trials in which both the initial detection methodology and histology have been assessed by blinded panels of pathologists.

Inflammatory Diseases of the Central and Peripheral Nervous System in Patients with Systemic Lupus Erythematosus: Autoantibody Findings and Clinical Phenotype (P6.108)

Inflammatory Diseases of the Central and Peripheral Nervous System in Patients with Systemic Lupus Erythematosus: Autoantibody Findings and Clinical Phenotype (P6.108)

The Effect of Chemotherapy on Peripheral Nervous System in Patients with Lympho/Myeloproliferative Disorders (P6.285)

The Effect of Chemotherapy on Peripheral Nervous System in Patients with Lympho/Myeloproliferative Disorders (P6.285)

Cutaneous sensory and autonomic denervation in CADASIL.

To assess the involvement of the peripheral nervous system in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by means of immunofluorescence and confocal analysis of punch skin biopsies. We recruited 14 unrelated patients with CADASIL (M/F = 9/5; age 53.9 ± 10.5 years) and 52 healthy controls (M/F = 31/21; age 53.8 ± 9.8). Patients underwent clinical and neuroradiologic assessment. Three-millimeter punch skin biopsies were taken from the fingertip, the thigh, and the distal leg and processed using indirect immunofluorescence and a panel of primary antibodies to mark vessels and sensory and autonomic nerve fibers. Intraepidermal nerve fibers (IENF), Meissner corpuscles (MC), and sudomotor, vasomotor, and pilomotor nerves were assessed using confocal microscopy. In patients, compared to controls, we found a severe loss of IENF at the distal leg (p < 0.01), at the thigh (p < 0.01), and at the fingertip (p < 0.01) with a non-length-dependent pattern and a loss of MC (p < 0.01). A severe sudomotor, vasomotor, and pilomotor nerve fiber loss was found by semiquantitative evaluation. Along with nerve loss, a severe derangement of the vascular bed was observed. In our patient population, sensory and autonomic denervation did not correlate with age, sex, type of mutation, or MRI involvement. We found an involvement of the peripheral nervous system in patients with CADASIL through the assessment of cutaneous somatic and autonomic nerves. The neurovascular derangement observed in the skin may reflect, although to a lesser extent, what happens in the CNS.

A Comprehensive Rehabilitation Approach in a Patient With Serious Neuropsychiatric Systemic Lupus Erythematosus.

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.

Clinical and functional status of the peripheral nervous system in patients with diabetic polyneuropathy

The recommendations presented information about the current relevance of the study of the nervous system in degenerative diseases of the spine. We give general neurological examination and special technique, modern algorithm for diagnosis and treatment strategy. The publication is intended for neurologists, internists, neurosurgeons, trauma, physical therapists, reflexologist, general practitioners and family medicine.

Clinical and functional status of the peripheral nervous system in patients with diabetic polyneuropathy

It seems impossible at the moment to stem the incidence of diabetes despite the enormous efforts to address this global problem. We have examined 30 patients with type 2 diabetes to study the clinical and functional status of the peripheral nervous system in patients with diabetic distal polyneuropathy. Our works showed the importance of both clinical and electroneuroneuromiographic examination of patients with diabetes who have or do not have objective manifestations of polyneuropathy. This allows for early detection of the initial effects of polyneuropathy. In patients with symptomatic stage of diabetic polyneuropathy, this method allows to establish the pattern, nature, and severity of lesions of fibers of peripheral nerve trunks.

The clinical and functional state of peripheral nervous system during the treatment of patients with diabetic polyneuropathy

The state of the peripheral nervous system and treat- ment of patients with diabetic polyneuropathy is global problem. To study the clinical and functional status of the peripheral nervous system in patients with diabetic distal polyneuropathy we have examined 30 patients with type 2 diabetes. Our research showed the importance of both clinical and electroneuromyographic examination for patients with diabetes who may have or do not to have objective evidence of polyneuropathy. This allows for early detection of initial effects of polyneuropathy and improve treatment tactics.

Malignant Involvement of the Peripheral Nervous System in Patients with Cancer: Multimodality Imaging and Pathologic Correlation

The clinical and imaging evaluation of peripheral neuropathies in patients with cancer is challenging. It is critically important to differentiate malignant invasion of the peripheral nervous system from nonmalignant causes, such as radiation-induced neuritis, neuropathy associated with chemotherapy, and inflammatory neuropathies. Contrast material-enhanced magnetic resonance (MR) imaging is the initial noninvasive test of choice; however, interpretation can be challenging when the anatomic features are distorted by prior surgery, radiation, or both. Fluorine 18 ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is an imaging adjunct to MR imaging that is particularly helpful for evaluating peripheral nerves because the metabolic activity depicted with (18)F-FDG PET/CT helps differentiate malignant from benign disease and assists in making certain management decisions. For example, sites of high (18)F-FDG activity in a peripheral nerve can be targeted to increase the diagnostic yield of a biopsy because malignant involvement of peripheral nerves can be patchy. Of note, (18)F-FDG PET/CT can show clinically unsuspected metastases elsewhere in the body. If cancer is found, (18)F-FDG PET/CT allows excellent assessment of treatment response. (18)F-FDG PET/CT is also useful in evaluating primary nerve sheath tumors in that such tumors with low metabolic activity on FDG PET/CT images are unlikely to be malignant, although the specificity is limited. It is essential to have a good understanding of the imaging characteristics of benign and malignant causes of peripheral neuropathy if (18)F-FDG PET/CT is to be used effectively for accurate diagnosis.