Severe Neuropathy Research Articles

Neuroprotective potential of Alpinia calcarata and HPLC analysis of stigmasterol against cisplatin-induced neuropathy in rat model

Cisplatin is a chemotherapeutic agent known for causing severe peripheral neuropathy as a side effect, impacting patients’ quality of life by damaging nerve tissues. This study aims to explore the neuroprotective effects of the ethanolic extract of Alpinia calcarata Roscoe rhizome (EEACR) and stigmasterol identified by high-performance liquid chromatography (HPLC) in a rat model of cisplatin-induced neuropathy. Male Wistar rats were divided into control, cisplatin-induced neuropathic, and two intervention groups receiving different concentrations of EEACR (250 and 500 mg/kg). Neuropathy was induced with cisplatin administered intraperitoneally at a dose of 2 mg/kg per week for five weeks. The intervention groups were treated orally with EEACR daily during the induction period. Treatment with EEACR showed a significant attenuation of neurotoxicity as evidenced by behavioural improvements in mechanical allodynia, thermal hyperalgesia, and cold allodynia. HPLC analysis confirmed the presence of stigmasterol in EEACR, which may contribute to its therapeutic effects. Biochemical assessments revealed a significant decrease in oxidative stress markers and an increase in antioxidant enzyme activities, including superoxide dismutase, catalase, and glutathione peroxidase, in the nervous tissues of EEACR-treated rats. Histopathological examination indicated a reduction in nerve damage and enhanced preservation of myelin and axonal structures in the treatment groups. The findings from this study suggest that EEACR, enriched with stigmasterol, offers promising neuroprotective effects against cisplatin-induced neuropathy in rats.

Clinical significance of upper arm motor nerve conduction velocity in cubital tunnel syndrome.

Retrograde denervation occurs in severe entrapment neuropathy. This study aimed to investigate changes in motor nerve conduction velocity (MNCV) at the upper arm, specifically proximal to the elbow, in cubital tunnel syndrome (CuTS) and to correlate these changes with preoperative severity and postoperative outcomes. We retrospectively reviewed 95 elbows with 81 patients with CuTS for preoperative severity, and then 67 elbows with 60 of these patients who underwent anterior subcutaneous transposition surgery for postoperative outcome, classified into favorable and unfavorable groups according to Messina grade. The reduction of upper arm MNCV was correlated with aging, decreased compound muscle action potentials of abductor digiti minimi muscle, loss of sensory nerve action potentials, and modified McGowan grade. Postoperative assessment revealed lower MNCV values in the "unfavorable" group compared to the "favorable" group at 1 month, 6 months, and the last follow up. At each time point, the optimal cut-off value of upper arm MNCV for predicting postoperative outcomes was 54.1 m/s. Upper arm MNCV might be a useful predictor of poor surgical outcome. Ulnar nerve MNCV at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery.

Most Carpal Tunnel Releases Address Moderate or Severe Median Neuropathy.

The role of surgery in normal or very mild median neuropathy can be questioned given that surgery in the absence of pathophysiology may offer only nonspecific effects that can be achieved without surgery, which raises ethical concerns. It's also important to avoid misdiagnosis: given that mild median neuropathy is prevalent and generally well-accommodated, notable symptoms from mild median neuropathy can signal unhelpful thoughts and feelings of distress that are a more pressing health priority. We identified 38 studies that categorized electrodiagnostic (EDX) measured median neuropathy severity among people being evaluated for carpal tunnel syndrome. We converted the different EDX grades used into one general grading classification. The Kruskal-Wallis test was used to compare the ratio of moderate/severe to mild/normal EDX findings between tests ordered by a surgeon or a nonoperative clinician. The median (interquartile range) ratio of moderate/severe to mild/normal EDX findings of median neuropathy at the carpal tunnel was 1.2 (0.91 to 1.8) among tests ordered by nonoperative clinicians and 3.3 (1.5 to 5.3) among tests ordered by surgeons (P = .0023). Only 4.1% of the patients who had EDX testing ordered by a surgeon had no measurable neuropathy. There were zero patients with normal EDX findings in 10 of the 17 (59%) studies in surgeon practices and in 10 of the 21 (48%) in the practices of nonoperative clinicians. The observation that in case series documenting EDX severities of median neuropathy, surgeons are mostly treating and operating on moderate to severe pathophysiology, emphasizes that while mild median neuropathy is highly prevalent it is uncommonly considered for surgery. Level II, Prognostic study.

Using biothesiometer, Neuropathy Symptom Score, and Neuropathy Disability Score for the early detection of peripheral neuropathy: A cross-sectional study.

Patients with peripheral neuropathy could have damaged peripheral nerves, which leads to sensory and motor dysfunction. Diabetes, infections, and trauma are the major causes of peripheral neuropathy. Vibratory perception threshold (VPT) tools are commonly used to detect peripheral neuropathy. This study aims to determine the assessment of peripheral neuropathy through the different diagnostic tools in the community in Malaysia. A total number of 1283 participants were recruited from the seven retail pharmacies located in Selangor, Malaysia. The peripheral neuropathy test was conducted based on VPT tools on both feet using the digital biothesiometer. Following that, Neurological Symptom Score (NSS) and Neurological Disability Score (NDS) were taken from the participants to assess the neurological symptoms. Participants had an average age of 40.6 ± 12.9 years and were mostly of Chinese ethnicity (54.1%). The findings show that increasing age was associated with more severe peripheral neuropathy across the various assessment tools, but gender differences were found with the biothesiometer test and ethnicity has severity in the biothesiometer and disability scores. The sensitivity and specificity of the biothesiometer test were 0.63 and 0.84, respectively. The combined tool NSS and NDS had high specificity and a high positive predictive value, suggesting that it could be a reliable indicator of peripheral neuropathy when both scores are elevated. The findings show that the biothesiometer test, NSS, and NDS are considered screening VPT tools for diagnosing peripheral neuropathy. However, further evaluation and diagnostic testing are necessary in cases of a positive test result.

ID: 333609 Healthcare Costs and Medical Utilization Patterns Associated with Painful and Severe Painful Diabetic Peripheral Neuropathy

ID: 333609 Healthcare Costs and Medical Utilization Patterns Associated with Painful and Severe Painful Diabetic Peripheral Neuropathy

Melatonin mitigates vincristine-induced peripheral neuropathy by inhibiting TNF-α/astrocytes/microglial cells activation in the spinal cord of rats, while preserving vincristine's chemotherapeutic efficacy in lymphoma cells

Vincristine (VCR), an anti-tubulin chemotherapy agent, is known to cause peripheral and central nerve damage, inducing severe chemotherapy-induced peripheral neuropathy (CIPN). Although melatonin has been recently recognized for its potential anti-neuropathic effects, its efficacy in countering VCR-induced neuropathy remains unclear. This study examines the neuroprotective potential of melatonin against VCR-induced neuropathy using a rat model. Neuropathic pain was induced through 10 VCR injections (0.1 mg/kg/day i.p.), administered in two five-day cycles with a two-day break. Melatonin treatment started two days before VCR administration and continued daily throughout the experiment. Rats were assigned to five groups: control, VCR, and three melatonin-treated groups receiving VCR with melatonin (5, 10, or 20 mg/kg/day i.p.). We assessed mechanical (von-Frey and Randall-Selitto tests) and thermal (hot-plate and tail-flick tests) hyperalgesia, motor coordination (rotarod test), and sciatic nerve conduction velocity (NCV). Changes in body weight, spinal cord histopathology (H&E), and proinflammatory markers (TNF-α, IL-1β, and IL-6), reactive astrocytes (GFAP) and microglial cells (IBA-1) were also assessed, as well as spinal cord degeneration (Nissl stain) and demyelination (LFB stain and MBP). Finally, the effect of melatonin on the cytotoxic activity of VCR against EL4 lymphoma cells was assessed using an MTT assay. Our results indicated that melatonin coadministration with VCR preserved spinal cord architecture, elevated nociceptive thresholds, improved motor coordination, enhanced NCV, and maintained normal body weight gain. Melatonin also reduced inflammation, decreased reactive astrocytes and microglia, and prevented neurodegeneration and demyelination in the spinal cord. Importantly, melatonin did not affect VCR's cytotoxic activity in cancer cells.

Establishment and characterization of three human pluripotent stem cell lines from Charcot-Marie-Tooth disease Type 4B3 patients bearing mutations in MTMR5/Sbf1 gene

Myotubularin-Related Protein 5 (MTMR5) is an inactive, poorly characterized D3-phosphatidylinositol phosphatase. Mutations in MTMR5 have been linked to Charcot-Marie-Tooth Disease Type 4B3 (CMT4B3), a rare, early-onset, recessive peripheral neuropathy. Here, we describe the establishment and validation of three human induced pluripotent stem cell (iPSC) lines derived from unrelated CMT4B3 patients, each harboring homozygous MTMR5/Sbf1 mutations. Current MTMR5 -/- animal models do not clearly link Sbf1 mutations to severe neuropathy, so such a resource is highly desired to further elucidate the relationship between MTMR5 dysfunction and peripheral nerve degeneration.

Characteristics and outcome of chronic inflammatory demyelinating polyradiculoneuropathy patients according to their diagnostic certainty based on the 2021 EAN/PNS criteria

IntroductionTo describe the clinical characteristics and long term outcome of CIDP patients according to 2021 EAN/PNS diagnostic certainty categories. MethodsWe reviewed clinical data, response to treatment, cerebrospinal fluid examination, and nerve conduction studies parameters of 39 adult “CIDP” and 24 “possible CIDP” patients. Data were collected at diagnosis and after one (T1), two (T2), three (T3) and five years (T5). ResultsAt diagnosis, “possible CIDP” patients' phenotypes were more atypical (especially focal/multifocal, p < .01) and “CIDP” patients had a higher NIS and INCAT scores (p = .08 and 0.08). Compared to baseline: median NIS score decreased in “CIDP” and was stable in “possible CIDP” patients at T1 (p < .05), T2 (p < .05) and T3 (p < .01); median MRC score slightly increased in “CIDP” and was stable in “possible CIDP” patients at T2 (p < .05); and INCAT disability scale slightly decreased in “CIDP” and was stable in “possible CIDP” patients at T3 (p < .05). The proportion of moderate to severely disabled (mRS > 2) patients in “possible CIDP” group was higher than in “CIDP” group (not significant). “CIDP” patients had a better objective response to immunotherapy (59 % responders) than “possible CIDP” patients (29 % responders, p < .05), especially among typical CIDP patients (86 % of responders in “CIDP” versus 33 % of responders in “possible CIDP” patients, p < .05). Conclusion“CIDP” patients had a more severe neuropathy, estimated with the NIS and INCAT scores, and “possible CIDP” patients had a more atypical phenotype at baseline. Our data suggest that long-term patient outcome and response to immunotherapy is better in “CIDP” than “possible CIDP”.

Prevalence of Chemotherapy-Induced Peripheral Neuropathy Among Cancer Patients and Its Effects on Quality of Life: A Survey Study

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment, leading to nerve damage and impairing patients' quality of life.Objective: To evaluate the prevalence of CIPN among cancer patients and its effects on their quality of life.Methods: A cross-sectional study was conducted at Allied Hospital, Pinum Cancer Hospital, and Aziz Fatima Hospital in Faisalabad, Pakistan. The study included 54 cancer patients (20 males, 34 females) aged 13-71 years, undergoing chemotherapy for at least six months. Patients were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy 20-item scale (EORTC-QLQ-CIPN20) and the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Data were analyzed using SPSS version 25, with descriptive statistics and chi-square tests performed to evaluate associations.Results: CIPN was prevalent in 90.7% of patients, with mild (59.3%), moderate (27.8%), and severe (3.7%) neuropathy levels. Neuropathy was significantly correlated with reduced quality of life (p = 0.663).Conclusion: CIPN is highly prevalent among cancer patients and significantly affects their quality of life. Early detection and management are crucial to mitigate these effects.

Fluorescein Angiography for Monitoring Neural Blood Flow in Chronic Nerve Compression Neuropathy: Experimental Animal Models and Preliminary Clinical Observations.

Pathologies associated with neural blood disturbance have been reported in patients with chronic nerve compression (CNC) neuropathy. Fluorescein angiography (FAG) and laser Doppler flowmetry (LDF) are effective for real-time peripheral nerve blood flow assessment. However, their reliability in severe neuropathy models in large animals or clinical conditions remains unclear. Initially, we aim to apply FAG to two different CNC animal models and evaluate their characteristics in comparison with those of LDF. In FAG, we quantified the peak luminance at the compression site following fluorescein injection. Then, we positioned the LDF probe at the center of the compression site and recorded the blood flow. Subsequently, we analyzed whether the FAG characteristics obtained in this animal experiment were consistent with those of clinical studies in patients with severe carpal tunnel syndrome (CTS). In the CNC rat model, FAG and LDF effectively monitored reduced neural blood flow over time. We observed significant blood flow reduction using both techniques in a newly developed severe CNC rabbit model. Notably, FAG correlated strongly with the compound muscle action potential (CMAP) amplitude in electrodiagnostic findings, unlike LDF. As a next step, we performed FAG after open carpal tunnel release in clinical cases of CTS. FAG correlated significantly with preoperative CMAP amplitude. This indicates FAG's importance for assessing nerve blood flow during surgery, potentially improving diagnostic accuracy and surgical outcomes.

Different Patterns of Autoantibody Secretion by Peripheral Blood Mononuclear Cells in Autoimmune Nodopathies.

Autoimmune nodopathies with antibodies against the paranodal proteins show a distinct phenotype of a severe sensorimotor neuropathy. In some patients, complete remission can be achieved after treatment with rituximab whereas others show a chronic course. For optimal planning of treatment, predicting the course of disease and therapeutic response is crucial. We stimulated peripheral blood mononuclear cells in vitro to find out whether secretion of specific autoantibodies may be a predictor of the course of disease and response to rituximab. Three patterns could be identified: In most patients with anti-Neurofascin-155-, anti-Contactin-1-, and anti-Caspr1-IgG4 autoantibodies, in vitro production of autoantibodies was detected, indicating autoantigen-specific memory B cells and short-lived plasma cells/plasmablasts as the major source of autoantibodies. These patients generally showed a good response to rituximab. In a subgroup of patients with anti-Neurofascin-155-IgG4 autoantibodies and insufficient response to rituximab, no in vitro autoantibody production was found despite high serum titers, indicating autoantibody secretion by long-lived plasma cells outside the peripheral blood. In the patients with anti-pan-Neurofascin autoantibodies-all with a monophasic course of disease-no in vitro autoantibody production could be measured, suggesting a lack of autoantigen-specific memory B cells. In some of them, autoantibody production by unstimulated cells was detectable, presumably corresponding to high amounts of autoantigen-specific plasmablasts-well in line with a severe but monophasic course of disease. Our data suggest that different B-cell responses may occur in autoimmune nodopathies and may serve as markers of courses of disease and response to rituximab.

Investigating the Prevalence of Autonomic Neuropathy in Diabetic Patients with Urinary Irritation Symptoms Without a Known Cause.

Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause. In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography. The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05). Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

Docetaxel-induced severe neuropathy, a case of breast cancer with GTSP1 polymorphism.

Breast cancer, the most prevalent cancer among women, often requires chemotherapy with docetaxel being a key agent. However, docetaxel-inducted peripheral neuropathy (DIPN) can adversely impact patients' quality of life. This case discusses an unusual instance of severe DIPN leading to wheelchair dependence in a 35-years old woman undergoing neoadjuvant treatment for locally advanced breast cancer. Following anthracycline and cyclophosphamide cycles without neurological symptoms, docetaxel administration resulted in progressive neuropathy. Despite dose reduction, the patient developed severe paraesthesias, foot weakness, and eventually wheelchair dependence. Docetaxel's microtubule-stabilizing mechanism, vital for cell division, may disrupt axonal structures, causing sensory and motor neuropathy. While rare, severe motor neuropathy, leading to wheelchair dependence, poses a significant challenge. The frequency of DIPN varies, with docetaxel exhibiting lower neuropathy rates than other taxanes. Risk factors include age, diabetes mellitus, cumulative dose, and genetic polymorphisms in GSTP1 and ABCB1. In our case, despite the patient being young, fit and without diabetes, severe DIPN occured, suggesting a potential genetic predisposition. Genetic variations, such as GSTP1 polymorphisms have been associated with DIPN. Our patient carried GSTP1 (I1e105Val) mutations, emphasizing the need for further research to establish their role as risk factors. This case underscores the importance of recognizing severe DIPN, even in atypical patient profiles. Genetic factors, like GSTP1 polymorphisms, may contribute to DIPN risk. Large-scale studies are crucial to establishing the significance of these genetic variations in DIPN susceptibility.

Embraced: On hands and nerves

AbstractIn 2001, I experienced severe radial neuropathy, leading to permanent dysfunctions in the fingers of my left hand. In this personal account of nerve damage, medical and surgical treatment, and adaptation, I first describe the sequence of neuropathies, then turn to how through serendipity, the brace enabled other connections—nervelines—with individuals and places. The brace is a metonym of a severed nerve with its associated loss of movement and capacity; it is also both a functional orthotic and an affordance. It carries me forward, activating other nervelines and networks to make things happen. I write of literal and metaphoric nerves, evolving connectivities, and fiber lines, thought lines and collaborations. I then extend the idea of nervelines and networks to global connnections; I emphasize how the organization of labor, the distribution of goods and services, and the expectations of workers shape body histories and life outcomes.

Post-marketing drug safety surveillance of enfortumab vedotin: an observational pharmacovigilance study based on a real-world database.

Enfortumab vedotin (EV) is an antibody-drug conjugate (ADC) that has been approved by the FDA for patients with locally advanced or metastatic urothelial carcinoma (UC). This study presents a comprehensive pharmacovigilance analysis of the post-marketing safety profile of EV in the real-world based on the US Food and Drug Administration Adverse Event Reporting System (FAERS). Adverse event (AE) reports regarding EV between January 2020 and December 2023 were obtained from the FAERS database. The standardized MedDRA query (SMQ) narrow search AEs on the preferred term (PT) level were used. Disproportionality analysis was performed to identify the AE signals for EV with the reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN). A total of 2,216 reports regarding EV were included in the present study. SMQ analysis results indicated that a stronger strength signal was found in severe cutaneous adverse reactions, retroperitoneal fibrosis, and peripheral neuropathy. A total of 116 significant disproportionality PTs referring to 14 system organ classes (SOCs) were retained by disproportionality analysis, with 49 PTs not listed on the EV drug label. Frequently reported EV-related AEs included rash, peripheral neuropathy, decreased appetite, alopecia, and pruritus. The time to onset of the majority of EV-related AEs was within 30 days (66.05%), with only 0.73% events occurring after 1 year. The disproportionality analysis highlights that dermatologic toxicity and peripheral neuropathy were the major AEs induced by EV. The potential AEs not listed on the drug label were mainly related to gastrointestinal, hepatic, and pulmonary events. Further research is needed to confirm and explore the EV-related AEs in clinical practice.

The Role of Dietary Anthocyanins for Managing Diabetes Mellitus-Associated Complications.

Diabetes mellitus (DM) is an intricate metabolic disorder marked by persistent hyperglycemia, arising from disruptions in glucose metabolism, with two main forms, type 1 and type 2, involving distinct etiologies affecting β-cell destruction or insulin levels and sensitivity. The islets of Langerhans, particularly β-cells and α-cells, play a pivotal role in glucose regulation, and both DM types lead to severe complications, including retinopathy, nephropathy, and neuropathy. Plant-derived anthocyanins, rich in anti-inflammatory and antioxidant properties, show promise in mitigating DM-related complications, providing a potential avenue for prevention and treatment. Medicinal herbs, fruits, and vegetables, abundant in bioactive compounds like phenolics, offer diverse benefits, including glucose regulation and anti-inflammatory, antioxidant, anticancer, anti-mutagenic, and neuroprotective properties. Anthocyanins, a subgroup of polyphenols, exhibit diverse isoforms and biosynthesis involving glycosylation, making them potential natural replacements for synthetic food colorants. Clinical trials demonstrate the efficacy and safety of anthocyanins in controlling glucose, reducing oxidative stress, and enhancing insulin sensitivity in diabetic patients, emphasizing their therapeutic potential. Preclinical studies revealed their multifaceted mechanisms, positioning anthocyanins as promising bioactive compounds for managing diabetes and its associated complications, including retinopathy, nephropathy, and neuropathy.

Comparative Analysis of Diabetic Neuropathy Examination Scores and Nerve Conduction Velocity in Patients with Diabetic Neuropathy

Background: Diabetic neuropathy is a prevalent consequence of diabetes, resulting in substantial morbidity. Precise evaluation is essential for prompt intervention and control. The study assessed the correlation and effectiveness of the Diabetic Neuropathy Examination (DNE) scores and Nerve Conduction Velocity (NCV) as diagnostic tools in individuals with diabetic neuropathy. Methods: An observational research was done, comprising 200 diabetic patients who were diagnosed with diabetic sensory-motor polyneuropathy. Participants completed Dynamic Neuromuscular Examination (DNE) grading and Nerve Conduction Velocity (NCV) testing. The data were analysed using SPSS version 20.0. Results: The study found a considerable negative correlation (r = -0.68, p &lt; 0.001) between DNE scores and NCV results. Higher DNE scores were associated with lower NCV values. Specifically, 20% of participants had mild neuropathy, 40% had moderate neuropathy, and 40% had severe neuropathy according to DNE scores. NCV testing revealed that 65% of participants had abnormal nerve conduction, with 25% showing mild reduction, 25% moderate reduction, and 15% severe reduction. Multivariate regression confirmed that DNE scores are significant predictors of NCV outcomes (Beta = -0.52, p &lt; 0.001), even after adjusting for confounding variables such as gender, age, diabetes duration, and HbA1C levels. Conclusion: DNE scoring is a reliable tool for assessing neuropathy severity in diabetic patients, correlating well with NCV results. Integrating DNE scoring in routine clinical practice can enhance the early detection and management of diabetic neuropathy. Recommendations: Routine use of DNE scoring along with NCV testing is recommended for comprehensive evaluation of diabetic neuropathy. Further research should explore additional diagnostic tools to improve early detection and intervention. Keywords: Diabetic Neuropathy, Diabetic Neuropathy Examination Score, Nerve Conduction Velocity Testing, Diabetic Polyneuropathy, Neuropathy Assessment..

Surgical and radiosurgical outcomes for Koos grade 3 vestibular schwannomas.

This study aimed to reveal the preferred initial treatment for Koos grade 3 vestibular schwannomas (VS). We performed a two-institutional retrospective study on 21 patients with Koos grade 3 VS undergoing resection at Yokohama Medical Center and 37 patients undergoing radiosurgery at Yokohama Rosai Hospital from 2010 to 2021. Tumor control, complications, and functional preservation were compared. The median pre-treatment volume and follow-up duration were 2845 mm3 and 57.0 months, respectively, in the resection group and 2127 mm3 and 81.7 months, respectively, in the radiosurgery group. In the resection group, 16 (76.2%) underwent gross total resection, and three patients (14.3%) experienced regrowth; however, no one required additional treatment. In the radiosurgery group, the tumor control rate was 86.5%, and three cases (8.1%) required surgical resection because of symptomatic brainstem compression. Kaplan-Meier analyses revealed that tumors with delayed continuous enlargement and large thin-walled cysts were significantly associated with poor prognostic factors (p = 0.0027, p < 0.001). The pre-radiosurgery growth rate was also associated with the volume increase (p = 0.013). Two cases (9.5%) required additional operation due to complications such as post-operative hematoma and cerebrospinal fluid leaks in the resection group, whereas temporary cranial neuropathies were observed in the radiosurgery group. Two patients (9.5%) had poor facial nerve function (House-Brackmann grading grade 3) in the resection group, while no one developed facial paresis in the radiosurgery group. Trigeminal neuropathy improved only in the resection group.Radiosurgery can be considered for the treatment of Koos grade 3 VS for functional preservation. However, resection may also be considered for patients with severe trigeminal neuropathy or a high risk of volume increments, such as large thin-walled cysts and rapid pre-treatment growth.

Healthcare costs and medical utilization patterns associated with painful and severe painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. It is associated with a poor quality of life and high costs of care. This study investigated the impact of painful DPN on healthcare costs and resource utilization. This was a retrospective analysis of administrative claims of adult patients with diabetes (type 1 or 2) from Optum's de-identified Clinformatics® Data Mart Database. Patients were assigned to four cohorts by presence of DPN and pain severity, based on diagnoses and prescription patterns in a one-year baseline. All-cause and diabetes-associated costs were calculated for the year following the index DPN diagnosis. Risk factors associated with presence of severely painful DPN were evaluated. Relative to those without DPN, patients who had DPN without pain, painful DPN (PDPN), or severe PDPN incurred respective increases of $3,093, $9,349, and $20,887 in average annual all-cause costs. More than half of costs from painful/severe DPN were for prescriptions and inpatient hospitalization. Severe PDPN was associated with elevated odds of diabetic amyotrophy (OR: 8.09; 95% CI: 6.84-9.56), diabetic foot ulcers (OR: 6.54, 95% CI: 6.32-6.76), and loss of mobility (OR: 2.54, 95% CI: 2.48-2.60), among other complications. Painful DPN is associated with higher healthcare costs and resource utilization, and a greater risk of debilitating conditions that limit quality of life. Future research should focus on better treatment options and more aggressive pain management strategies to reduce the negative impacts of DPN.

Optic nerve decompression through pterional and supraorbital approaches in the treatment of severe traumatic optic neuropathy.

To investigate the effectiveness of optic nerve decompression (OND) in the treatment of severe traumatic optic neuropathy (TON) through pterional and supraorbital approaches, and to identify the prognostic factor for postoperative visual acuity (VA) following OND. Patients with severe TON treated with OND through either pterional or supraorbital approach in our institute from September 2019 to June 2022 were retrospectively reviewed in this study. Demographic information, trauma factors, the interval between trauma and complete blindness, the interval between trauma and surgery, and the associated craniofacial traumas were recorded. Hospitalization days and the postoperative VA of patients in two groups were compared. There were 54 severe TON patients with NLP included in this study; 21 patients underwent OND through the pterional approach, and the other 33 underwent the supraorbital approach. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 3.2 and 10.7 ± 2.9 days (p = 0.58), the mean durations of follow-up were 18.9 ± 4.3 and 20.8 ± 3.7 months (p = 0.09), and the average circumference of OND were 53.14 ± 15.89 ◦ (range 220 ◦ -278◦) and 181.70 ± 6.56◦ (range 173 ◦ -193◦) (p<0.001). The overall improvement rates of pterional and supraorbital approaches are 57.1% and 45.5% (p = 0.40), respectively. Optic canal fracture (OCF) was revealed to be significantly associated with postoperative VA in the supraorbital approach (Binary: p = 0.014, CI: 1.573-57.087; Ordinal: p = 0.003, CI: 1.517-5.503), but not in the pterional approach. In the group of supraorbital approach, patients with OFC had a higher rate of a better outcome (78.6%) than those without (21.4%). Patients with severe traumatic TON may benefit from OND through either the pterional or supraorbital approach. OCF is a potential prognostic factor for postoperative VA following OND through the supraorbital approach.