Peripheral neuropathy in patients with gout, beyond focal nerve compression: a cross-sectional study.

Neuropathies secondary to tophus compression in gout patients are well known; however, limited data exist on other types of peripheral neuropathies (PN). Our aim was to describe PN frequency, characteristics, distribution, patterns, and associated factors in gout patients through clinical evaluation, a PN questionnaire, and nerve conduction studies (NCS). This cross-sectional descriptive study included consecutive gout patients (ACR/EULAR 2015 criteria) from our clinic. All underwent evaluation by Rheumatology and Rehabilitation departments, with IRB approval. Based on NCS, patients were categorized as PN + (presence) or PN- (absence). PN + patients were further classified as local peripheral neuropathy (LPN) or generalized somatic peripheral neuropathy (GPN). We enrolled 162 patients, 98% male (72% tophaceous gout). Mean age (SD): 49.4 (12) years; mean BMI: 27.9 (6.0) kg/m2. Comorbidities included dyslipidemia (53%), hypertension (28%), and obesity (23.5%). Abnormal NCS: 65% (n = 106); 52% LPN, 48% GPN. PN + patients were older, had lower education, and severe tophaceous gout. GPN patients were older, had lower education, and higher DN4 scores compared to LPN or PN- groups (p = 0.05); other risk factors were not significant. Over half of gout patients experienced neuropathy, with 48% having multiplex mononeuropathy or polyneuropathy. This was associated with joint damage and functional impairment. Mechanisms and risk factors remain unclear. Early recognition and management are crucial for optimizing clinical outcomes and quality of life in these patients. Key Points Peripheral neuropathies in gout patients had been scarcely reported and studied. This paper report that: • PN in gout is more frequent and more diverse than previously reported. • Mononeuropathies are frequent, median but also ulnar, peroneal and tibial nerves could be injured. • Unexpected, generalized neuropathies (polyneuropathy and multiplex mononeuropathy) are frequent and associated to severe gout. • The direct role of hyperuricemia /or gout in peripheral nerves require further studies.

Vitaminas B1, B6, B12 y neuropatías periféricas: Consenso de expertos / Vitamins B1, B6, and B12 and peripheral neuropathies: International expert consensus

RESUMEN A partir de una revisión bibliográfica de la literatura se ha planeado y desarrollado un consenso de expertos internacionales sobre la utilización de las vitaminas B1, B6, B12 en sus déficits y en la neuropatía periférica que puede estar asociada a la misma, como tema que precia de esa aproximación aclaratoria para optimizar su manejo. Se plantearon varias cuestiones de discusión que se consideraron importantes y dignas de ser abordadas y aclaradas, conservando nueve de ellas para su discusión ulterior buscando el consenso en tres rondas consecutivas. Se han propuesto 41 recomendaciones sobre el manejo de estas condiciones, con unanimidad por parte de los participantes en el consenso. Con ellas se ha intentado aclarar puntos oscuros o controvertidos, facilitando la actitud del clínico ante ellos en la práctica médica actual.

ABSTRACT Based on a bibliographic review of the literature, a consensus of international experts has been carried out on the use of vitamins B1, B6, B12, in their deficiencies, and in the peripheral neuropathy that may be associated with them, to optimize the management of these conditions. Several questions considered important and worthy of being addressed and clarified were raised, retaining nine of them for further discussion to achieve consensus. Forty one recommendations on the management of these conditions have been proposed, with unanimity of the participants in the consensus. This has been an attempt to clarify controversial points, assisting the clinician's attitude in current medical practice.

Antinociceptive effect of plant-based natural products in chemotherapy-induced peripheral neuropathies: A systematic review.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most prevalent and difficult-to-treat symptoms in cancer patients. For this reason, the explore for unused helpful choices able of filling these impediments is essential. Natural products from plants stand out as a valuable source of therapeutic agents, being options for the treatment of this growing public health problem. Therefore, the objective of this study was to report the effects of natural products from plants and the mechanisms of action involved in the reduction of neuropathy caused by chemotherapy. The search was performed in PubMed, Scopus and Web of Science in March/2021. Two reviewers independently selected the articles and extracted data on characteristics, methods, study results and methodological quality (SYRCLE). Twenty-two studies were selected, describing the potential effect of 22 different phytochemicals in the treatment of CIPN, with emphasis on terpenes, flavonoids and alkaloids. The effect of these compounds was demonstrated in different experimental protocols, with several action targets being proposed, such as modulation of inflammatory mediators and reduction of oxidative stress. The studies demonstrated a predominance of the risk of uncertain bias for randomization, baseline characteristics and concealment of the experimental groups. Our findings suggest a potential antinociceptive effect of natural products from plants on CIPN, probably acting in several places of action, being strategic for the development of new therapeutic options for this multifactorial condition.

Egos has a reduced capacity to predicts GBS prognosis in Northeast Brazil.

OBJECTIVE: The Erasmus Guillain Barre Outcome Score (EGOS) is a prognostic model that predicts the chance of being able to walk independently at 6 months after Guillain Barré syndrome (GBS). This study was conducted aiming to determine the validity of EGOS in a Brazilian population. MATERIAL AND METHODS: Data collected from GBS patients in Rio Grande do Norte, Brazil, were used to determine the validity of EGOS. GBS disability score was assessed in the second week of disease and at 6 months. RESULTS: A total of 206 subjects were studied. The Brazilian patients were younger, with a more severe clinical presentation, with higher percentage of cranial nerve involvement and upper respiratory infection. There was no difference relative to sex or presence of anti-gangliosides antibodies. The demyelinating variant was more common (73.9%). However, only 24% of the Brazilians with EGOS 5.5-7 were not able to walk after 6 months, compared to 52% to European Group. Nine patients (3.8%) presented nodopathies, of these four had an EGOS >5, but only one of the latter group was unable to walk after 6 months of GBS. CONCLUSIONS: Erasmus Guillain Barre Outcome Score was not a good predictor for the ability to walk after 6 months of GBS in Rio Grande do Norte, Brazil. Differences could be that the Brazilian GBS were younger, or alternatively, it could be due to a different infection profile or in the incidence of nodopathies.

[Neurosurgical position causes peripheral nerve injuries?] / ¿La posición neuroquirúrgica ocasiona lesión de nervio periférico?

BACKGROUND: Positioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment. OBJECTIVE: To analyze the frequency of peripheral nerve injury secondary to surgical positioning. MATERIALS AND METHODS: Prospective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analyzed by neurological exploration in order to detect injury and relate with risk factors already described. RESULTS: In this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours' duration; statistically significant correlation with body weight greater than 85kg. CONCLUSION: The incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.

Polineuropatía asociada a infección por VIH. Revisión del tema ypresentación de un caso / Polyneuropathy associated to VIH infection. Review of the topic and case report

La infección por el virus de inmunodeficiencia humana (VIH) constituye un problema de salud pública. Laafectación neurológica en los pacientes infectados por el VIH es frecuente, involucrando tanto al sistema nerviosocentral como al periférico, y en algunos casos puede ser la primera manifestación de la infección. Entrelas afecciones neurológicas, las neuropatías periféricas pueden observarse en el 100% de las autopsias. Lasmismas pueden adoptar diferentes formas, que por lo general dependen de la fase de la enfermedad en la quese encuentre el paciente. Las neuropatías autoinmunes como el síndrome de Guillain-Barré y la polineuropatíadesmielinizante inflamatoria crónica (CIDP) aparecen en los estadios iniciales de la infección, cuando el conteode CD4 está ligeramente disminuido. La CIDP tiene criterios clínicos y electrofisiológicos bien definidos quela diferencian de otras formas de neuropatías periféricas, responde bien al tratamiento inmunomodulador,pero su diagnóstico puede ser difícil de realizar debido a su forma insidiosa de comienzo. Se realiza una breverevisión de las neuropatías periféricas que pueden asociarse a la infección por VIH y se presenta un caso deasociación de esta infección con CIDP.

Infection by Human Immune deficiency (VIH) is a public health problem. Neurological affection in those patients is frequent, it involve central and peripheral nervous system. In some cases neurological involvement is the first sign of the infection. Peripheral neuropathies are the most common of neurological illness associated to VIH infection; it could be observed in 100 % of autopsy. Autoimmune neuropathies like Guillain Barré and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) appear at initial phase of infection, when CD4 count is slight diminish. CIDP has defined clinic and electrophysiological criteria to differentiate it from other types of neuropathies, CIDP has a good response to immunomodulation treatment, it has an insidious start, which could difficult the diagnostic. We show a brief revision of peripheral neuropathic associated to VIH infection; we show a case with VIH infection and CIDP.

Current perception threshold and reaction time in the assessment of sensory peripheral nerve fibers through sinusoidal electrical stimulation at different frequencies

INTRODUCTION: The Perception Sensory Threshold (ST) for sinusoidal current stimuli at 5, 250, and 2,000 Hz is commonly used in the assessment of peripheral nerve fibers (C, Aδ, and Aβ, respectively). However, the neuroselectivity of these frequencies is far from consensus. In addition, Reaction Time (RT) measurements suggest that 2,000 Hz stimuli excite Aβ-fibers, 250 Hz Aβ- or Aδ-fibers, as well as 5 Hz Aβ-, Aδ- or C-fibers. Therefore, we suppose that the sinusoidal current neuroselectivity may be better observed if ST and RT parameters are jointly evaluated. In addition, we have investigated whether there are other sets of frequencies that could be used. METHODS: Thus this work investigates ST and RT for stimuli with frequency ranging from 1 to 3,000 Hz, on 28 healthy subjects aged from 19 to 44 years old (27.1±5.49). ST and RT dissimilarity among different frequencies was evaluated applying bi-dimensional Fisher Quadratic Discriminant. RESULTS: The lowest classification error (3.6%) was obtained for 1, 250, and 3,000 Hz. Error for 5, 250, and 2,000Hz was 16.7%. Stimulation frequency at 1 Hz evoked more sensations related to C-fibers (53% of reports) than to Aβ-fibers (36%). However, this behavior did not repeat itself at 5 Hz (only 21% of perceptions were related to C-fibers against 64% to Aβ-fibers). Sensations related to Aβ-fibers prevailed for the highest frequencies presented to the subjects (2,000 Hz - 82% and 3,000 Hz - 93%). Mean RT values showed a decreasing trend with frequency. CONCLUSION: These results suggest that frequencies 1, 250, and 3,000 Hz are more neuroselective than 5, 250, and 2,000 Hz for the evaluation of peripheral sensitive fibers. Furthermore, they show RT usefulness.

Teste de rotarod: contribuições no estudo das doenças neuromusculares, das síndromes extrapiramidas e das ataxias cerebelares / / The rotarod teste: contributions to the study of neuromuscular diseases, extrapyramidal syndromes and cerebellar ataxia

O uso de testes comportamentais e neurológicos é ferramenta essencial na caracterização fenotípica de modelos animais para doenças neurológicas. O teste da barra rotatória ou Rotarod é um dos mais antigos empregados na área de estudo dos efeitos motores induzidos por uso de drogas em estudos pré-clínicos e na descrição do fenótipo de mutantes induzidos geneticamente para doenças cerebelares, extrapiramidais e neuromusculares. A quantidade de informação disponível referente à metodologia e às interpretações do teste é muito ampla, contudo é muito limitada ainda a uniformidade nos testes empregados nos diversos estudos. O objetivo desta revisão é destacar as principais contribuições do teste para a Neurologia Experimental, a metodologia empregada na maioria dos serviços e pelo nosso grupo e os aspectos atuais do emprego da avaliação motora em roedores.

The use of behavioral and neurological testing is an essential tool in the phenotypic characterization of animal models for neurological diseases. The Rotarod test is one of the oldest employed in the study of the motor effects induced by drugs in preclinical studies and in the description of the phenotype of genetically induced mutants of cerebellar, extrapyramidal and neuromuscular disorders. The amount of information available regarding the methodology and interpretations of the test is very broad, yet the uniformity is still very limited in the tests used in different studies. The purpose of this review is to highlight the main contributions of the test for Experimental Neurology, the methodology used in most services and by our group and current aspects of the use of motor assessment in rodents.

Teste de rotarod: contribuições no estudo das doenças neuromusculares, das síndromes extrapiramidas e das ataxias cerebelares / / The rotarod teste: contributions to the study of neuromuscular diseases, extrapyramidal syndromes and cerebellar ataxia

O uso de testes comportamentais e neurológicos é ferramenta essencial na caracterização fenotípica de modelos animais para doenças neurológicas. O teste da barra rotatória ou Rotarod é um dos mais antigos empregados na área de estudo dos efeitos motores induzidos por uso de drogas em estudos pré-clínicos e na descrição do fenótipo de mutantes induzidos geneticamente para doenças cerebelares, extrapiramidais e neuromusculares. A quantidade de informação disponível referente à metodologia e às interpretações do teste é muito ampla, contudo é muito limitada ainda a uniformidade nos testes empregados nos diversos estudos. O objetivo desta revisão é destacar as principais contribuições do teste para a Neurologia Experimental, a metodologia empregada na maioria dos serviços e pelo nosso grupo e os aspectos atuais do emprego da avaliação motora em roedores.(AU)

The use of behavioral and neurological testing is an essential tool in the phenotypic characterization of animal models for neurological diseases. The Rotarod test is one of the oldest employed in the study of the motor effects induced by drugs in preclinical studies and in the description of the phenotype of genetically induced mutants of cerebellar, extrapyramidal and neuromuscular disorders. The amount of information available regarding the methodology and interpretations of the test is very broad, yet the uniformity is still very limited in the tests used in different studies. The purpose of this review is to highlight the main contributions of the test for Experimental Neurology, the methodology used in most services and by our group and current aspects of the use of motor assessment in rodents.(AU)

HIV-associated neuromuscular weakness syndrome in Brazil: report of the two first cases

We describe two Brazilian patients with HIV-associated neuromuscular weakness syndrome (HANWS), a unique clinical toxic syndrome that was recently reported in developed countries. Both patients were women, used stavudine and had hyperlactatemia, one of them with lactic acidosis. Eletrophysiological studies were consistent with axonal neuropathy. After discontinuation of antiretroviral therapy the patients had significant improvement in neurologic manifestations, and normalization of lactate levels. To our knowledge, this is the first report of HANWS in developing countries. Growing use of antiretroviral therapy in this setting, particularly stavudine, make it likely that similar cases will be observed.

Os autores descrevem dois pacientes brasileiros com a síndrome da fraqueza neuromuscular associada ao HIV, uma síndrome tóxica, clínicamente particular, que foi recentemente relatada em países desenvolvidos. Ambas pacientes eram do sexo feminino, usavam estavudina e apresentaram hiperlactatemia, uma delas com acidose láctica. Os exames electrofisiológicos foram consistentes com neuropatia axonal. As pacientes melhoraram significativamente das alterações neurológicas, assim como normalizaram os níveis de lactato, após descontinuar o uso dos antiretrovirais. Até onde sabemos, este é o primeiro relato da síndrome de fraqueza neuromuscular associada ao HIV em países em desenvolvimento. Nesse contexto, o uso crescente de antiretrovirais, particularmente a estavudina, possibilitarão que casos similares sejam observados.