Risk Factors For Peripheral Neuropathy Research Articles

Risk factors of paclitaxel-induced peripheral neuropathy in patients with breast cancer: a prospective cohort study.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe adverse reaction in taxane-based chemotherapy. This study aimed to analyze the risk factors of peripheral neuropathy in patients with breast cancer receiving paclitaxel chemotherapy to provide a reference for the early prevention of CIPN. We included 350 patients with breast cancer who received chemotherapy for the first time at the Tangshan People's Hospital between August 2022 and June 2023 and were followed for at least 3 months after the end of chemotherapy. The incidence of CIPN in patients with breast cancer was calculated, and risk factors for CIPN were analyzed using logistic regression analysis. The incidence rate of CIPN was 79.1%. Multifactor logistic regression analysis indicated that age ≥45 years [odds ratio (OR)=5.119, 95% confidence interval (CI)=1.395-18.780] and ≥60 years (OR=9.366, 95% CI=1.228-71.421), history of hypertension (OR=3.475, 95% CI=1.073-11.250), cumulative dose of chemotherapy drugs >900 mg (OR=4.842, 95% CI=1.961-5.946), vitamin D deficiency (OR=6.214, 95% CI=2.308-16.729), abnormal alanine aminotransferase (OR=3.154, 95% CI=1.010-9.844), anemia before chemotherapy (OR=2.770, 95% CI=1.093-7.019), infusion duration of chemotherapy drugs >30min (OR=3.673, 95% CI=1.414-9.539), body mass index ≥24 kg/m2 (OR=8.139, 95% CI=1.157-57.240), mild depression (OR=4.546, 95% CI=1.358-15.223), and major depression (OR=4.455, 95% CI=1.237-16.037) increased the risk of CIPN. Having a regular caregiver (OR=0.223, 95% CI=0.087-0.573), high levels of physical activity (OR=0.071, 95% CI=0.008-0.647), and strong social support (OR=0.048, 95% CI=0.003-0.682) were protective factors against CIPN. Clinical attention should be paid to patients with these risk factors, and active and effective preventive measures should be taken to reduce the occurrence of CIPN and improve the quality of life.

Correlation of nerve damage and peripheral neuropathy incidence using the MNSI and MDNS instrument approaches

The World Health Organization (WHO) reported that by 2030, diabetes mellitus would become the 7th leading cause of death. Diabetes mellitus is a chronic disease that causes various complications, one of which is peripheral neuropathy. Preventive efforts for peripheral neuropathy involve conducting detection examinations. The purpose of this study was to analyze nerve damage in peripheral neuropathy cases using the MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score) instruments. The study employed a cross-sectional study approach with a sample of 50 people, using total sampling as the sampling technique. The independent variable in this study was nerve damage, and the dependent variable was peripheral neuropathy. Data collection in the study was carried out using the MNSI and MDNS instruments to link the dependent and independent variables. Hypothesis analysis in this study was conducted using the Spearman's rho correlation test. The study found that autonomic, sensory, and motor damage correlated with peripheral neuropathy, with a P-value of < 0.05. Examinations in the feet of diabetics were significantly related to the level of peripheral neuropathy. However, there was no evidence of a correlation between the characteristics of the respondents and the incidence of peripheral neuropathy. The results of the nerve damage examination demonstrated a correlation between different types of damage, and the MNSI and MDNS instruments proved effective in detecting peripheral neuropathy damage. Future research should focus on more in-depth studies to explore the correlation of nerve damage in patients with diabetes mellitus detected at a young age and consider other variables, such as HbA1c levels, as potential risk factors for peripheral neuropathy.

Elevated liver enzymes and fasting glucose levels correlate with neuropathy in patients diagnosed with alcohol use disorder independently of the blood thiamine levels.

Chronic alcohol consumption is well known to cause peripheral neuropathy, affecting both small and large nerve fibers. The aim of this study was to correlate biochemical and neurophysiological findings and investigate possible biomarkers and risk factors for pathogenetic mechanisms of neuropathy in patients diagnosed with alcohol use disorder (AUD). Ninety patients diagnosed with AUD were enrolled in this prospective study over a period of 3 years. Serum biochemical parameters, as well as thiamine blood levels, were determined upon admission. Every subject was assessed by clinical neurological examination, followed by Nerve Conduction Studies, Quantitative Sensory Testing, and Sympathetic Skin Response. Fifty age and gender-matched patients without a diagnosis of AUD were used as the control group. Peripheral neuropathy was diagnosed in 54 patients (60%). Among them, pure large fiber neuropathy was found in 18 patients, pure small fiber neuropathy in 12 patients, and both large and small fiber neuropathy was diagnosed in 24 patients. Elevated liver enzymes and fasting glucose levels upon admission were significantly correlated with neuropathy. Lower blood thiamine levels (than reference) were found in seven patients and were not correlated with neuropathy. Our study suggests that alcohol-related liver dysfunction and hyperglycemia may contribute as risk factors of peripheral neuropathy in patients diagnosed with AUD, while blood thiamine levels do not correlate with neuropathy. Moreover, we suggest that liver enzymes and the De Ritis ratio could be potentially used as biomarkers for the incidence and severity of alcohol-related neuropathy.

Prevalence of Peripheral Neuropathy (PN) Among Patients with Asymptomatic Monoclonal Gammopathies: A Clinical & Electrophysiological Study

Introduction: Asymptomatic monoclonal gammopathies (MGUS, SMM or aWM) are common among adults >50y. Peripheral neuropathy (PN) refers to any disorder of the peripheral nervous system including mononeuropathies, and symmetrical or asymmetrical polyneuropathy. PN is also common among individuals >50y. Common risk factors include diabetes, vitamin deficiencies, alcohol, renal insufficiency, hypothyroidism, autoimmune diseases and exposure to neurotoxic medication. Epidemiological studies have shown an association between monoclonal gammopathies and PN but a mechanistic link has been established only for some (anti-MAG IgM-related PN, amyloidosis, POEMS syndrome etc). However, the true prevalence of PN among patients (pts) with monoclonal gammopathies is unknown and remains challenging to associate monoclonal gammopathy with PN. The aim of our study is to establish the prevalence of PN in a large cohort of pts with asymptomatic monoclonal gammopathy and identify potential determinants. Methods: This is an ongoing prospective, non-invasive study aiming to screen ~1500 pts with asymptomatic monoclonal gammopathies for PN. Pts under regular follow-up at the Department of Therapeutics, University of Athens, Greece are screened for neuropathic symptoms using the Michigan Neuropathy Screening Instrument (MNSI), a validated screening tool for the presence of PN that consists of 15 yes/no items. A cut off ≥ 4 has been proposed as a screening cut off in diabetic PN. All pts scoring ≥4 on MNSI and pts scoring <4 but without risk factors for PN were assessed clinically and electrophysiologically (EDX) with standard nerve conduction studies (NCS), sympathetic skin response (SSR) test and - if needed - electromyography (EMG) by a specialist. NCS protocol includes assessment of the median nerve (motor and sensory), superficial radial nerve (sensory), tibial nerve (motor) and sural nerve (sensory) conduction studies. Axonal PN was diagnosed when the sural to radial ratio (SRAR) is below 0.25 and/or the sural nerve action potential is below 6μV, demyelinating PN if the EAN/PNS criteria for demyelination are fulfilled and sympathetic dysfunction when the SSR amplitude was <500 uV. Results: As of to date, 320 pts (42.8% males, median 67y) with asymptomatic monoclonal gammopathy have been screened; 64.3% had a diagnosis of MGUS (72.3% IgG, 14.1% IgA, 6.3% IgM, 7.3% light chain only), 23.9% had SMM and 11.8% had aWM. Among enrolled pts, 217 (68%) had no common risk factors for PN and 82 pts (25.6%) had an MNSI score ≥4; the commonest symptoms were cramps (48.4%), weakness (26.9%) and pain when walking (26.3%). Among pts without risk factors for PN, 42 (19.4%) had an MNSI score ≥ 4 and the commonest symptoms were cramps (44.7%), pain when walking (22.1%) and weakness (21.7%) (Table 1). There was no difference in the prevalence of MNSI score ≥4 among pts with different paraprotein types. To date, 105 pts (41.9% males, median 66y) had EDX evaluation, of which 77 (73%) had no common risk factors for PN. Among the EDX evaluated pts, 23 (21.9%) had large fiber PN, 42 (40%) had sudomotor dysfunction and 53 (50.5%) had large fiber PN and/or sudomotor dysfunction. Among the cohort of pts without risk factors for PN, 13 (16.9%) had large fiber PN, 25 (32.5%) had sudomotor dysfunction and 34 (44.2%) had large fiber PN and/or sudomotor dysfunction. Nineteen pts that went through EDX were asymptomatic (MNSI=0), of those 4 (21.1%) had large fiber PN, 4 (21.1%) had sudomotor dysfunction and 7 (33.3%) had large fiber PN and/or sudomotor dysfunction. Only one patient, without other risk factors, had a demyelinating neuropathy while all other pts had a length-dependent axonal sensory or sensorimotor neuropathy. Pts with large fiber PN were older (73.7±11.4 vs 63±9.4, p<0.001) but no significant differences were found regarding sex, or paraprotein or light chain type. Pts with sudomotor dysfunction were more likely to have a non-IgM monoclonal gammopathy (90.2% vs 72.6 %, p=0.029). Conclusion: Peripheral neuropathy is common in pts with monocloncal gammopathies affecting ~20% of those without any other risk factors for PN. Although most pts with PN describe mild symptoms, both large fiber PN and sudomotor dysfunction may remain completely asymptomatic. This data provides a new insight into the prevalence of PN in pts with monoclonal gammopathies with implications for future research. The study is ongoing and updated results will be presented.

Sensory neuropathy complicated with de novo diabetes mellitus during levodopa‐carbidopa intestinal gel infusion in a patient with Parkinson's disease: A case report

AbstractLevodopa‐carbidopa intestinal gel therapy (LCIG), an effective treatment for advanced Parkinson's disease, can cause peripheral neuropathy. We present a 39‐year‐old man with LCIG‐related neuropathy with de novo diabetes mellitus (DM), decreased vitamin B6 and folate levels, and elevated homocysteine levels that developed over 2 years of LCIG treatment. Physicians should assess levels of levodopa metabolism‐associated vitamins and monitor risk factors of peripheral neuropathy, such as DM, before and after LCIG initiation.

Vitamin B12 Deficiency and Peripheral Neuropathy in patients with Type 2 Diabetes Mellitus Treated with Metformin. An integrative review

Background/Purpose: Type 2 diabetes mellitus (T2DM) is a worldwide pathology with several complications, and 50% of patients with T2DM develop peripheral neuropathy (PN) in the long term. The present study aimed to review the literature on the association between PN and vitamin B12 deficiency in patients with T2DM treated with metformin. Materials and methods: A literature review was carried out in the PubMed Central, Cochrane, Scielo, Scopus and Embase databases, from 2015 to 2021. We found 755 studies, of which 16 were included. Results: The serum level of vitamin B12 was lower in individuals with at least one neurological symptom. Treatment with metformin was associated with reduced serum vitamin B12 levels, and its use was defined as a probable cause of PN due to reduced vitamin B12. Studies that performed supplementation with methylcobalamin demonstrated significant improvement in neuropathic symptoms. Vitamin B12 supplementation therapy for diabetic patients undergoing metformin treatment has been suggested. Conclusion: Deficiency of vitamin B12 associated to metformin can be considered a risk factor for PN. Periodically evaluation of serum levels of vitamin B12 is recommended for patients on metformin treatment.

Analysis of clinical features and risk factors of peripheral neuropathy in patients with primary Sjögren's syndrome

ObjectiveTo observe the clinical features and efficacy of immunosuppressive therapy in patients with primary Sjögren's syndrome (PSS) combined with peripheral neuropathy (PN) syndrome and to explore the risk factors for PN in patients with PSS.MethodsSixty consecutive patients with PSS admitted to the Department of Rheumatology and Immunology, Wuhan No. 1 Hospital, from January 2014 to June 2020 were analysed retrospectively. Patients were divided into a PN group (N = 15) and a non-PN group (N = 45). The clinical characteristics of the two groups were compared, and the independent risk factors for PN combined with PSS were analysed by multivariate logistic regression. The patients with PSS combined with PN were followed up to observe the effect of immunosuppressive therapy.ResultsThe patients with PN had a longer course of disease than those without PN (z = − 3.225, P = 0.001), and the incidence of Raynaud's phenomenon, anti-SSB antibody, rheumatoid factor and hyperglobulinaemia was higher (all P < 0.05) in patients with PN than in those without PN. Multivariate logistic regression analysis showed that hyperglobulinaemia, RF and anti-SSB antibodies were independent risk factors for PN with PSS (P < 0.05). Fourteen patients with PSS-PN were treated with immunosuppressants. The clinical symptoms of 10 patients were relieved, and mRS scores of 10 patients were decreased.ConclusionPN is a common complication in PSS patients. Patients with PSS combined with PN have a longer course of disease and a significantly higher percentage of Raynaud's phenomenon, positive anti-SSB antibody, positive RF and hyperglobulinaemia. Immunosuppressive therapy was effective for partial remission of PN with PSS.

Insulin-regulated serine and lipid metabolism drive peripheral neuropathy

Diabetes represents a spectrum of disease in which metabolic dysfunction damages multiple organ systems including liver, kidneys and peripheral nerves1,2. Although the onset and progression of these co-morbidities are linked with insulin resistance, hyperglycaemia and dyslipidaemia3–7, aberrant non-essential amino acid (NEAA) metabolism also contributes to the pathogenesis of diabetes8–10. Serine and glycine are closely related NEAAs whose levels are consistently reduced in patients with metabolic syndrome10–14, but the mechanistic drivers and downstream consequences of this metabotype remain unclear. Low systemic serine and glycine are also emerging as a hallmark of macular and peripheral nerve disorders, correlating with impaired visual acuity and peripheral neuropathy15,16. Here we demonstrate that aberrant serine homeostasis drives serine and glycine deficiencies in diabetic mice, which can be diagnosed with a serine tolerance test that quantifies serine uptake and disposal. Mimicking these metabolic alterations in young mice by dietary serine or glycine restriction together with high fat intake markedly accelerates the onset of small fibre neuropathy while reducing adiposity. Normalization of serine by dietary supplementation and mitigation of dyslipidaemia with myriocin both alleviate neuropathy in diabetic mice, linking serine-associated peripheral neuropathy to sphingolipid metabolism. These findings identify systemic serine deficiency and dyslipidaemia as novel risk factors for peripheral neuropathy that may be exploited therapeutically.

Risk factors for taxane-induced peripheral neuropathy in patients with breast cancer.

This study investigated the clinical risk factors for peripheral neuropathy induced by docetaxel and albumin-bound paclitaxel (AP) in patients with breast cancer. This prospective observational study recruited 268 patients between March 2019 and December 2020. Patient information was obtained through the query system for laboratory test results, patient consultations, and scale evaluations. Neuropathic symptoms were followed up throughout and until 3 months after taxane chemotherapy. Univariate and multivariate analyses were used to find the risk factors for overall and moderate-severe taxane-induced peripheral neuropathy (TIPN). Cumulative dose (odds ratio [OR] = 3.533, 95% confidence interval [CI]: 1.797-6.944, p < 0.001), body mass index (BMI) (OR = 2.926, 95% CI: 1.621-5.281, p < 0.001), body surface area (BSA) (OR = 1.724, 95% CI: 1.011-2.941, p = 0.045), and hypocalcemia (OR = 4.899, 95% CI: 1.518-15.811, p = 0.008) all increased the risk of TIPN. Only cumulative dose (OR = 2.577, 95% CI: 1.161-5.719, p = 0.020) and BSA (OR = 2.040, 95% CI: 1.073-3.877, p = 0.030) were independent risk factors for moderate-severe TIPN. Cumulative dose, BMI, BSA, and hypocalcemia are all risk factors for overall TIPN, whereas cumulative dose and BSA are risk factors for moderate-severe TIPN. Patients with breast cancer who have high BMI, large BSA, hypocalcemia, and large cumulative dose may be at risk of TIPN, and intervention measures must be actively carried out for them.

Prevalence and risk factors of peripheral neuropathy among young type 2 diabetes mellitus patients attending a tertiary care hospital in upper Assam: A cross-sectional study

Abstract Background: Diabetic peripheral neuropathy (DPN), being the most common and early complication of diabetes mellitus, results in significant morbidity and debilitating sequelae in the form of foot ulcers, infection, and amputation. Due to the disease’s longevity, young type 2 diabetes constitutes a high risk for developing neuropathy, and screening of patients for DPN becomes crucial. Objectives: This study aimed to estimate the prevalence and identify the associated risk factors of peripheral neuropathy among young type 2 diabetes mellitus patients attending a tertiary care hospital in upper Assam. Materials and Methods: This cross-sectional study was conducted from July 1, 2022 to September 30, 2022 in the Department of Medicine. A total of 165 participants attending the outpatient Department and the Diabetic clinic, diagnosed with type 2 diabetes below the age of 45 years were recruited using non-random consecutive sampling. Patients were then interviewed using a pre-designed, pre-tested schedule. DPN was assessed by detection of vibration perception threshold (VPT) using a biothesiometer, the cutoff value for which was taken as 15 V. Results: The prevalence of DPN as assessed by VPT using biothesiometer was 13.9%. The prevalence of mild, moderate, and severe neuropathies was 9.1%, 3.6%, and 1.2%, respectively. DPN was found to have a significant association with the duration of diabetes and hypertension. Socio-demographic characteristics, smoking, alcohol intake, physical activity, anti-diabetic medication, and dyslipidemia were not found to have a significant association with DPN. Conclusion: This study has stressed the importance of screening for hypertension even in the younger age groups as well as the need for early detection of DPN, which can aid in taking necessary actions to impede the disease’s progression.

Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer.

PurposeObstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity.DesignSingle center cross-sectional study.MethodsSixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance.ResultsNo significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping.ConclusionsOSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

Fiber selectivity of peripheral neuropathy in patients with Parkinson's disease.

To determine the function of each type of peripheral nerve fiber and investigate the possible role of levodopa (LD) in peripheral neuropathy (PN) in Parkinson's disease (PD) patients. We enrolled 60 patients with idiopathic PD. All PD patients were divided into three groups: levodopa exposure >3years (LELD), levodopa exposure ≤3years (SELD) and de novo patients with PD (NOLD). The current perception threshold (CPT), which was measured by Neurometer at 2000, 250 and 5Hz, the level of homocysteine, Vitamin B12 and folic acid in plasma, were compared with those of sex- and age-matched healthy controls (HCs). Current perception threshold was higher at 250Hz (p<.05) and 5Hz (p<.05) in the LELD group than the NOLD, SELD, and control group. CPT was lower at 5Hz in the NOLD than in the HCs group (p<.05). The CPT of the more affected side of PD patients was positively correlated with H-Y stage at 5Hz current stimulation (r=.42, p=.01). Multivariate logistic regression analysis showed that elevated homocysteine levels were the risk factor of sensory nerve injury in PD patients (p<.01). Serum homocysteine levels were positively correlated with levodopa (LD) daily dose, LD equivalent daily dose, and LD cumulative lifetime dose (p<.05). Peripheral neuropathy in PD patients can occur in the early stage of PD exhibiting as hyperesthesia and is fiber selectivity, especially for Aδ and C nerve fibers. PN in PD patients is related to PD itself and long-term LD exposure. Elevated plasma homocysteine is a risk factor for PN in PD patients.

DF21-0668 Bariatric Surgery Induced Weight Loss Relation to Peripheral Neuropathy by Sudoscan: Clinical Study

Background: Obesity is a risk factor for peripheral neuropathy (PN). PN is found in subjects with diabetes, pre-diabetes and metabolic syndrome. Bariatric surgery (BS) – most successful obesity treatment results in stable weight loss. Though, BS impact on PN is unknown. Aim: To investigate impact of weight loss on PN in type 2 diabetes (T2DM) post-BS by Sudoscan. Method: A male (51yrs), T2DM diagnosed 8yrs ago; pre-operative examination results: weight-145 kg, BMI-42kg/m2, HbA1c-10.2%, T/A -150/90mmHg (on ACE/Amlodipine); vitamins D/B12 - within the normal range. Patient was on intensive insulin therapy (sol. Glulisine, short-acting insulin/SAI+ sol. Glargine, long-acting insulin/LAI): LAI - 24 IU/at bedtime; SAI-12x12x12 IU / before main meals. Neuropathy tests/BNT (monofilament, tip-term, vibration tests) were moderately positive; Sudoscan revealed moderate PN (scores 50 feet/48 hands). Diagnosis: T2DM, diabetic neuropathy, obesity class III, AH II. Treatment: BS (sleeve-gastrectomy) was performed; dietary therapy, multivitamins, calcium citrate, iron, vitamins D/ B12 were initiated post-operatively. Results: Post-operatively weight loss and glycemic profile improved, insulin doses gradually reduced, finally insulin and antihypertensive therapy were stopped. Post-operative examination results (month 3): HbA1c-6.7%, BMI-33.2kg/m2, T/A -130/80 mmHg; no symptoms of high ABP and/or hyperglycemia. Neuropathic complains and test scores improved: BNT - weak positive; by Sudoscan - moderate neuropathy (scores 55 feet/50 hands). Vitamins D/B12 and ionized calcium levels - within normal range. Patient was physically active. Dietary therapy/physical activity continued. Examination results (month 6): HbA1c-5.9%, BMI-28.9kg/m2, T/A - 120/70 mmHg. BNT results - weak positive; by Sudoscan - moderate neuropathy (scores 68 feet/56 hands). Treatment: dietary therapy, physical activity, calcium citrate, vitamins D/B12, multivitamins. Examination results (month 12): HbA1c-5.4%, BMI-26.5kg/m2, T/A -125/70 mmHg; general condition - satisfactory, mood/motivation – high; no PN symptoms; weight loss continued. BNT were near normal; no neuropathy by Sudoscan (scores 75 feet/68 hands). Discussion: The case study shows positive impact of weight loss on glycemia control, ABP and PN. Data of some research indicate positive effect weight loss on diabetic/non-diabetic PN. Further studies are necessary to approve these findings.

Potential risk factors for peripheral neuropathy in patients with type 2 diabetes mellitus: a case control study from central Rajasthan

Background: Peripheral neuropathy is one of the most common and debilitating but preventable complications of diabetes mellitus, with significant morbidity as it often leads to foot ulceration and amputation. Therefore, this study was aimed to identify the potential risk factors for diabetic peripheral neuropathy (DPN) which can affect its progression.Methods: This case-control study was conducted on 240 patients with type 2 diabetes mellitus which included 120 patients with clinical evidence of DPN as cases and 120 patients without clinical evidence of DPN as controls. DPN was assessed clinically by neuropathic symptoms and neurological examination using 10 g 5.07 Semmes–Weinstein monofilament and vibration digital biothesiometer. Data regarding presence of potential risk factors were collected from all participants and analyzed using logistic regression analysis to measure an association with DPN.Results: A significant and independent association of advancing age, longer duration of diabetes, hyperglycemia, poor glycemic control, autonomic neuropathy and retinopathy with DPN (p&lt;0.05) was observed. Hypertension, dyslipidemia, smoking, gender, body mass index, method of diabetes control and angiotensin converting enzyme inhibitor usage were not found be associated with DPN.Conclusions: Since hyperglycemia and poor glycemic control were only modifiable risk factors for DPN, intensive glycemic control and primary prevention are the cornerstones for reducing the incidence or slowing the progression of neuropathy and improving quality of life in diabetic patients.

Prevalence and Risk Factors for Peripheral Neuropathy in Chinese Patients With Gout.

ObjectivePeripheral neuropathies (PNs) are a group of disorders that affect the peripheral nervous system. PN in gout has been scarcely described. This study is conducted to determine the prevalence and related risk factors of PN, as assessed by vibration perception threshold (VPT) in patients with gout.MethodsA total of 442 patients were included in the cross-sectional study. The VPT values were measured by using the Biothesiometer sensory quantitative tester on each patient. The VPT value of either limb higher than 15 V was considered abnormal and is considered to have PN. The univariate and multivariate logistic regression models were used to identify risk factors for PN in patients with gout.ResultsWe included 442 patients with gout, 97.5% men, 26.9% tophaceous gout, mean age 45.5 ± 15.2 years, and 7.4 ± 4.6 years of disease duration. The prevalence of PN in patients with gout was 11.1%. Patients in the abnormal VPT group were older, had a longer gout duration, and had significantly higher levels of waist circumference, waist-to-hip ratio, systolic blood pressure (SBP), and erythrocyte sedimentation rate (ESR), as compared to patients in the normal vibration group (P < 0.05). The univariate logistic regression analysis demonstrated that there was a significant association between abnormal VPT and age, duration of gout, SBP, C-reactive protein, ESR, presence of tophi, and estimated glomerular filtration rate (eGFR) in all the subjects (P < 0.05). The multivariate logistic regression analysis indicated that age (odds ratio, 1.094) and presence of tophi (odds ratio, 1.048) were independent risk factors for PN in patients with gout.ConclusionThe abnormal VPT was significantly correlated with age and presence of tophi in patients with gout and the VPT level may be useful as a screening tool for assessment of PN in gout.

Is Vitamin D Deficiency an Independent Risk Factor for Peripheral Neuropathy?

Is Vitamin D Deficiency an Independent Risk Factor for Peripheral Neuropathy?

Prevalence and Risk Factors of Peripheral Neuropathy in Parkinson's Disease.

A lesser studied aspect of Parkinson's disease (PD) is its associated peripheral sensory-motor neuropathy. Peripheral neuropathy is an intriguing aspect of PD, a problem not given sufficient attention and which if tackled properly could make a difference to the multifaceted sufferings of the PD patient. Studies regarding the prevalence of peripheral neuropathy and its risk factors in patients with PD are scarce from the Indian subcontinent. This prospective observational study was conducted in a tertiary care teaching hospital in South India. Patients diagnosed with idiopathic Parkinson's disease (IPD) were screened and enrolled. All the patients underwent detailed evaluation of symptoms, signs, and electrophysiology (Nerve conduction study, Sympathetic skin response), stimulated skin wrinkling with Eutectic Mixture of Local Anesthetics. Patients found to have large/small fiber neuropathy underwent additional tests to exclude other causes of neuropathy. A total of 154 patients with IPD were enrolled in the study (mean age: 61.96 ± 9.15 years, mean duration of disease was 4.08 ± 3.16 years). The mean Hoehn and Yahr (H and Y) score was 2.3 ± 0.825 and the mean Unified Parkinsons Disease Rating Scale (UPDRS)-3 score in the ON state was 23.07 ± 11.14. The mean cumulative levodopa dose was 482.68 ± 651.76 (median: 292; range: 4728.57) grams. Peripheral neuropathy was found in 49 patients (31.8%), large fiber in 28 (18.2%) and small fiber in 47 (30.5%); an overlap of large and small fiber neuropathy was seen in 26 patients (16.9%). Around 34% of patients had serum homocysteine levels >20 mg/dl. In univariate analysis, duration of disease, levodopa cumulative dose, serum homocysteine level, H and Y score, UPDRS-3 ON score, Toronto Clinical Neuropathy Score (P < 0.001 for all), age at presentation, and rigidity predominant presentation (P = 0.02 for both) were associated with large fiber neuropathy. All of these variables were also associated with the presence of small fiber neuropathy (P = 0.004 for age at presentation and P < 0.001 for rest), except the type of PD presentation. However, in multivariate logistic regression analysis, only duration of disease, levodopa cumulative dose, and H and Y score were associated with the presence of large and small fiber neuropathy. In our cohort, majority of the patients were in early-stage PD and around one-fifth and one-third of patients suffer from large and small fiber polyneuropathy, respectively. Large and small fiber neuropathy in PD is mainly associated with duration of disease, levodopa cumulative dose, and H and Y score.

Median Nerve Affection in Hypertensive Patients with and without Diabetes High-Resolution Ultrasound Assessment.

PurposeDiabetes is a documented risk factor for peripheral neuropathy. It was reported that associated hypertension could increase this risk. The present study aimed to assess the effect of hypertension and diabetes on median nerve using high-resolution ultrasound.MethodsThe study includes 50 hypertensive patients (HTN group), 50 diabetic patients (DM group), 50 patients with coexisting diabetes and hypertension (HTN + DM group) and 50 healthy controls. Median nerve affection in the studied groups was studied by vibration perception thresholds (VPT). The median nerve cross-sectional area was determined at the nerve cross-sectional area of the median nerve at the carpal tunnel by high-resolution ultrasound. Clinical symptoms were assessed using Toronto Clinical Severity Score (TCSS).ResultsThere was significantly higher median nerve CSA in all patient groups in comparison to controls. HTN + DM group had significantly higher median nerve CSA when compared with DM group. Patients with peripheral neuropathy in HTN + DM and DM groups had significantly higher median nerve CSA than patients without. Using ROC curve analysis, it was shown that median CSA could successfully distinguish patients with peripheral neuropathy from patients without in HTN + DM group [AUC (95% CI): 0.71 (0.54–0.89)] and in DM group [AUC (95% CI): 0.86 (0.72–0.99)].ConclusionHypertensive patients with and without diabetes have significantly higher median nerve CSA when compared with controls.

Comparison of prevalence and risk factors for peripheral neuropathy between patients with HIV infection and patients with concurrent HIV and diabetes mellitus

The ageing population living with HIV is predisposed to non-communicable comorbidities, including diabetes. Peripheral neuropathy (PN) can occur in both conditions, and it is thought co-existence of both illnesses has a synergistic impact on PN. We sought to identify the prevalence of PN in our population of patients with HIV infection compared with those with both HIV and diabetes.

Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts

Peripheral neuropathy is associated with substantial morbidity, but risk factors other than diabetes are largely uncharacterized. The aim of this study was to describe the prevalence and risk factors for peripheral neuropathy in adults with and without diabetes from two different population-based studies in the US. We performed a cross-sectional analysis of 5200 black and white participants from NHANES (1999–2004, age 40–85 years) and 3362 black and white participants from the ARIC Study (2016–2017, age 70–89 years) who underwent monofilament testing for peripheral neuropathy using a shared protocol. We used logistic regression to quantify age, sex, and race-adjusted risk factor associations for peripheral neuropathy among middle-aged (40–69 years) and older (≥ 70 years) adults. The age, sex, and race-adjusted prevalence of peripheral neuropathy (decreased sensation on monofilament testing) was 10.4% for middle-aged adults in NHANES, 26.8% for older adults in NHANES, and 39.2% for older adults in ARIC. Diabetes was an important risk factor, but more strongly associated with peripheral neuropathy in middle-aged (OR ~ 5 for long-standing diabetes) compared to older adults (ORs ~ 1.5–2). Male sex (ORs ~ 2), black race (ORs ~ 1.3–1.5), and greater height (ORs ~ 1.5–3) were robust risk factors for peripheral neuropathy. Other risk factors included body mass index, education, and peripheral artery disease. The burden of peripheral neuropathy defined by abnormal monofilament testing among older adults is substantial, even among adults without diabetes. Studies are needed to understand the etiology and prognosis of peripheral neuropathy in the absence of diabetes.