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1.
Ideggyogy Sz ; 72(7-8): 285-288, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517463

RESUMO

Morvan syndrome is a rare disease characterized by peripheral nerve hyperexcitability, encephalopathy, dys-autonomia and significant insomnia. The patient, who was included in the present study, was followed-up at our clinics for confusion, myokymia, hyperhidrosis, epileptic seizures, tachycardia, agitation, hypokalemia, and hyponatremia. The cranial MRI of the patient demonstrated hyperintensities at the T2 and FLAIR sections of the medial temporal lobe and insular lobes. Electromyography and neurotransmission examination results were concordant with peripheral nerve hyperreactivity. Contactin-associated protein-like 2 antibodies and leucine-rich glioma inactivated protein 1 antibodies were detected as positive. The patient was diagnosed with Morvan syndrome; intravenous immunoglobulin and corticosteroid treatment was started. Almost full remission was achieved. This very rare syndrome implies challenges in diagnosis and treatment; however, remission can be achieved during the follow-up. In addition, caution is needed in the long-term follow-up of these patients regarding the development of malignancies.


Assuntos
Encefalopatias , Encéfalo/diagnóstico por imagem , Transtornos dos Movimentos/fisiopatologia , Doenças Musculares/fisiopatologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Corticosteroides/uso terapêutico , Autoanticorpos/sangue , Eletromiografia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Encefalite Límbica , Transtornos dos Movimentos/tratamento farmacológico , Doenças Musculares/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Convulsões/etiologia , Resultado do Tratamento
3.
J Clin Neurosci ; 67: 59-61, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227402

RESUMO

The aim of this study was to record all patients referred to a private outpatient clinic for electrodiagnostic consultation during one calendar year. The demographic data of the patients, the specialty of the referring physicians, the referral diagnosis, the electromyographic (EMG) diagnosis and the concordance of referral and EMG diagnosis among all the referring physician's specialties were recorded. There were one thousand patients (385 men and 615 women). 65.7% of the patients were referred from orthopedists and 22.4% from neurologists. EMG was normal in 498 patients (49.8%). Abnormal in 47.3% of the patients referred by orthopedists and 58.9% of those referred by neurologists. Carpal tunnel syndrome (CTS) was the most frequent electrophysiological diagnosis (26.8%), followed by polyneuropathy (8.9%), radiculopathy (7.1%) and mononeuropathy (4.6%). In this study electrodiagnostic consultation was abnormal in only half of the referred patients. The high proportion of normal EDX tests in this study denotes the need for more accurate clinical diagnosis in order to reduce the time spent and resources. The orthopedist is the initial physician to whom patients with neuromuscular symptoms are seen in the majority of cases. Neurologists seem to be more familiar with neuromuscular symptoms and diseases.


Assuntos
Instituições de Assistência Ambulatorial , Eletromiografia , Doenças do Sistema Nervoso Periférico/diagnóstico , Encaminhamento e Consulta , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurologistas , Cirurgiões Ortopédicos
4.
Cornea ; 38(7): 921-926, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985521

RESUMO

PURPOSE: Corneal confocal microscopy (CCM) is an imaging method to detect loss of nerve fibers in the cornea. The impact of image quality on the CCM parameters has not been investigated. We developed a quality index (QI) with 3 stages for CCM images and compared the influence of the image quality on the quantification of corneal nerve parameters using 2 modes of analysis in healthy volunteers and patients with known peripheral neuropathy. METHODS: Images of 75 participants were a posteriori analyzed, including 25 each in 3 image quality groups (QI 1-QI 3). Corneal nerve fiber length (CNFL) was analyzed using automated and semiautomated software, and corneal nerve fiber density and corneal nerve branch density were quantified using automated image analysis. Three masked raters assessed CCM image quality (QI) independently and categorized images into groups QI 1-QI 3. In addition, statistical analysis was used to compare interrater reliability. Analysis of variance was used for analysis between the groups. Interrater reliability analysis between the image ratings was performed by calculating Fleiss' kappa and its 95% confidence interval. RESULTS: CNFL, corneal nerve fiber density, and corneal nerve branch density increased significantly with QI (P < 0.001, all post hoc tests P < 0.05). CNFL was higher using semiautomated compared with automated nerve analysis, independent of QI. Fleiss kappa coefficient for interrater reliability of QI was 0.72. CONCLUSIONS: The quantification of corneal nerve parameters depends on image quality, and poorer quality images are associated with lower values for corneal nerve parameters. We propose the QI as a tool to reduce variability in quantification of corneal nerve parameters.


Assuntos
Córnea/inervação , Doenças da Córnea/diagnóstico , Técnicas de Diagnóstico Oftalmológico/normas , Processamento de Imagem Assistida por Computador/normas , Microscopia Confocal/normas , Fibras Nervosas/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
5.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015244

RESUMO

Diabetic muscle infarction is an unusual condition with distinctive clinical characteristics seen in patients with prolonged and uncontrolled diabetes. Clinical findings and imaging study are unique and challenging. Patients usually present with acute unilateral severe muscular pain and swelling, particularly in the lower extremities. The presentation is difficult to distinguish from other common conditions such as deep venous thrombosis and infectious myositis. However, early recognition of the clinical presentation and appropriate imaging selection can lead to the diagnosis and avoid unnecessary muscle biopsy. Here, we report a case of diabetic muscle infarction in a patient with poorly controlled type 1 diabetes who had a good clinical response after an early detection and appropriate treatment.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Infarto/patologia , Músculo Esquelético/patologia , Analgésicos Opioides/uso terapêutico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Infarto/diagnóstico por imagem , Infarto/etiologia , Insulina/administração & dosagem , Insulina/uso terapêutico , Imagem por Ressonância Magnética/métodos , Músculo Esquelético/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Tramadol/administração & dosagem , Tramadol/uso terapêutico , Resultado do Tratamento , Ultrassonografia/métodos , Adulto Jovem
6.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948392

RESUMO

Nonaka myopathy is an autosomal recessive and slowly progressive distal myopathy. It is part of a rare group of myopathies predominantly affecting the distal limb musculature. Over 150 cases have been reported across the Middle East, Japan and Europe. We report the case of a 33-year-old woman presenting with symmetrical upper and lower limb weakness, most severely affecting the distal muscle groups. After extensive neurological investigation including neurophysiology, muscle biopsy and genetic analysis, she was finally diagnosed with Nonaka myopathy and treated conservatively with physiotherapy.


Assuntos
Miopatias Distais/diagnóstico , Debilidade Muscular/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Adulto , Diagnóstico Diferencial , Miopatias Distais/complicações , Feminino , Humanos , Debilidade Muscular/etiologia
7.
Z Rheumatol ; 78(4): 339-351, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30944998

RESUMO

Peripheral neuropathies are probably an under-diagnosed complication of many rheumatic diseases. In some cases they take a mild clinical course, in others they cause severe impairment of patients' quality of life. A precise diagnosis and etiological classification are of major importance for successful treatment and prognosis of peripheral neuropathies. A detailed patient history and physical examination are the foundation of every diagnostic approach. Electrophysiological studies are obligatory when peripheral neuropathy is suspected, whereas nerve or nerve-muscle biopsies are indicated only in selected cases. Therapeutic approaches are often complicated by a lack of evidence. They correspond to frequently tested immunosuppressive treatment of the underlying disease, such as glucocorticoids, cyclophosphamide, mycophenolate mofetil and intravenous immunoglobulins and are based on the symptomatic pain treatment of other neuropathies. As first-line treatment gabapentin, pregabalin, duloxetine, venlafaxine and tricyclic antidepressants are frequently used.


Assuntos
Doenças do Sistema Nervoso Periférico , Doenças Reumáticas , Cloridrato de Duloxetina , Humanos , Manejo da Dor , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Qualidade de Vida , Doenças Reumáticas/complicações
8.
Rev Assoc Med Bras (1992) ; 65(2): 281-286, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30892456

RESUMO

INTRODUCTION: Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES: This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS: This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS: A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION: Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.


Assuntos
Doenças do Sistema Nervoso Periférico , Uremia , Humanos , Transplante de Rim , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/terapia , Diálise Renal , Uremia/diagnóstico , Uremia/fisiopatologia , Uremia/terapia
9.
Int J Mol Sci ; 20(6)2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30909387

RESUMO

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent side effects caused by antineoplastic agents, with a prevalence from 19% to over 85%. Clinically, CIPN is a mostly sensory neuropathy that may be accompanied by motor and autonomic changes of varying intensity and duration. Due to its high prevalence among cancer patients, CIPN constitutes a major problem for both cancer patients and survivors as well as for their health care providers, especially because, at the moment, there is no single effective method of preventing CIPN; moreover, the possibilities of treating this syndrome are very limited. There are six main substance groups that cause damage to peripheral sensory, motor and autonomic neurons, which result in the development of CIPN: platinum-based antineoplastic agents, vinca alkaloids, epothilones (ixabepilone), taxanes, proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide). Among them, the most neurotoxic are platinum-based agents, taxanes, ixabepilone and thalidomide; other less neurotoxic but also commonlyused drugs are bortezomib and vinca alkaloids. This paper reviews the clinical picture of CIPN and the neurotoxicity mechanisms of the most common antineoplastic agents. A better understanding of the risk factors and underlying mechanisms of CIPN is needed to develop effective preventive and therapeutic strategies.


Assuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores , Dano ao DNA , Humanos , Neoplasias/tratamento farmacológico , Estresse Oxidativo , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/metabolismo , Platina/administração & dosagem , Platina/efeitos adversos , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Espécies Reativas de Oxigênio , Transdução de Sinais
10.
Eur Radiol ; 29(7): 3480-3487, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30903330

RESUMO

OBJECTIVE: Detection and pattern analysis of fascicular nerve hyperintensities in the T2-weighted image are the backbone of magnetic resonance neurography (MRN) as they may represent lesions of various etiologies. The aim of this study was to assess the prevalence of fascicular nerve hyperintensities in healthy individuals with regard to a potential association with age or cerebral white matter lesions. METHODS: Sixty volunteers without peripheral nerve diseases between the age of 20 and 80 underwent MRN (high-resolution T2-weighted) of upper (median, ulnar, radial) and lower (sciatic, tibial) extremity nerves and a fluid-attenuated inversion recovery (FLAIR) sequence of the brain. Presence of peripheral nerve hyperintensities and degree of cerebral white matter lesions were independently rated by two blinded readers and related to each other and to age. T test with Welch's correction was used for group comparisons. Spearman's correlation coefficients were reported for correlation analyses. RESULTS: MR neurography revealed fascicular hyperintensities in 10 of 60 subjects (16.7%). Most frequently, they occurred in the sciatic nerve (8/60 subjects, 13.3%), less frequently in the tibial nerve at the lower leg and the median, ulnar, and radial nerves at the upper arm (1.7-5.0%). Mean age of subjects with nerve hyperintensities was higher than that of those without (60.6 years vs. 48.0 years, p = 0.038). There was only a weak correlation of nerve lesions with age and with cerebral white matter lesions, respectively. CONCLUSION: Fascicular nerve hyperintensities may occur in healthy individuals and should therefore always be regarded in conjunction with the clinical context. KEY POINTS: • MR neurography may reveal fascicular hyperintensities in peripheral nerves of healthy individuals. Fascicular hyperintensities occur predominantly in the sciatic nerve and older individuals. • Therefore, fascicular hyperintensities should only be interpreted as clearly pathologic in conjunction with the clinical context.


Assuntos
Imagem por Ressonância Magnética/métodos , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Substância Branca/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Adulto Jovem
11.
Am J Case Rep ; 20: 330-334, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30862772

RESUMO

BACKGROUND Beriberi due to thiamine (vitamin B1) deficiency has two clinical presentations. Patients with dry beriberi present with neuropathy, and patients with wet beriberi present with heart failure, with or without neuropathy. Dry beriberi can mimic the most common form of Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Severe thiamine deficiency results in Wernicke's encephalopathy. This report of a case of dry beriberi and Wernicke's encephalopathy due to thiamine deficiency includes a review of the literature. CASE REPORT A 56-year old woman with a history of gallstone pancreatitis and protein-calorie malnutrition was treated six months previously with total parenteral nutrition (TPN). She initially presented at another hospital with paresthesia of the lower limbs, arms, and neck, and symptoms of encephalopathy. Initial diagnosis of GBS was made, based on magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings. Despite five days of intravenous immunoglobulin (IVIG) treatment, her encephalopathy worsened, requiring transfer to our hospital, where she required intubation and treatment with vasopressors. A repeat MRI of her brain showed changes consistent with Wernicke's encephalopathy. Following treatment with high-dose intravenous thiamine, her mental status improved within 48 hours, and by the third hospital day, she no longer required intubation. CONCLUSIONS Symptoms and signs of dry beriberi due to thiamine deficiency can mimic those of acute or chronic GBS. However, thiamine repletion leads to rapid clinical improvement and can prevent irreversible neurologic sequelae, including Korsakoff syndrome. Clinicians should consider thiamine deficiency in malnourished patients presenting with symptoms and signs of GBS.


Assuntos
Beriberi/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Deficiência de Tiamina/diagnóstico , Encefalopatia de Wernicke/etiologia , Beriberi/complicações , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico , Deficiência de Tiamina/complicações , Encefalopatia de Wernicke/diagnóstico
12.
Med Clin North Am ; 103(2): 383-397, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30704689

RESUMO

Peripheral neuropathy is a commonly encountered disorder in clinical practice. In light of an aging population and the diabetes and obesity pandemic, the prevalence of peripheral neuropathy is increasing, posing a significant public health concern. This article provides a diagnostic framework for neuropathies and summarizes treatment options.


Assuntos
Analgésicos/uso terapêutico , Doenças do Sistema Nervoso Periférico/diagnóstico , Analgésicos/efeitos adversos , Biópsia , Terapias Complementares , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso Periférico/tratamento farmacológico
13.
FP Essent ; 477: 11-15, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30747507

RESUMO

Peripheral neuropathies (PNs) are a group of conditions caused by damage to the peripheral nervous system. PN is a condition commonly seen in the family medicine setting and can lead to reduced quality of life due to pain, ulceration, and falls. More than 100 etiologies of PN have been identified; the most common are metabolic, drug-related, and systemic etiologies. Common treatable etiologies include diabetes and other medical conditions. Screening is recommended only for patients with suspected diabetic PN. The diagnosis of neuropathies is made primarily using the clinical history and physical examination results. Laboratory and electrodiagnostic tests can be used to identify the etiology of PN, and should be considered in atypical cases or if the diagnosis is uncertain. In some cases, management of the underlying cause of the neuropathy is indicated. Management includes adequate control of the blood glucose level in patients with diabetes and correction of vitamin deficiencies. Symptom control often is achieved with use of drugs.


Assuntos
Doenças do Sistema Nervoso Periférico , Acidentes por Quedas , Neuropatias Diabéticas , Humanos , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/terapia , Exame Físico , Qualidade de Vida
14.
BMC Cancer ; 19(1): 132, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736741

RESUMO

BACKGROUND: There are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy. PATIENTS AND METHODS: Multi-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies. RESULTS: In total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2-53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (rs = 0.15,p < 0.05-rs = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN. CONCLUSION: The historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Medidas de Resultados Relatados pelo Paciente , Doenças do Sistema Nervoso Periférico/diagnóstico , Prevalência , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença
15.
Pak J Pharm Sci ; 32(1): 125-130, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30772800

RESUMO

This retrospective study reports impact of diabetes on incidence rate of dose limiting symptoms of neurological toxicity and chemotherapy induced peripheral neuropathy (CIPN). Post-surgical colorectal cancer (CRC) patients with metastatic disease, treated with four different schedules of FOLFOX were included in this study. Neurological adverse effects were assessed by CTC v2.0. The incidence rate of adverse neurological symptoms in CRC patients, clinically diagnosed with diabetes (n=6) were compared with non-diabetic CRC patients (n=32). The results show that the difference in the incidence rate of paresthesia is significant (p=0.043) between diabetic and non-diabetic patients. The difference in the incidence rates of hypoesthesia (p=0.445), peripheral neuropathy (p=0.889), dizziness (p=0.445), insomnia (p=0.690), taste disturbances (p=0.258), and headache (p=0.498) in diabetic and non-diabetic CRC patients was not significant. The findings indicate that risk of frequent, distal and transient paresthesia within the first few minutes of Oxaliplatin infusion is higher in diabetic CRC patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Diabetes Mellitus/diagnóstico , Feminino , Fluoruracila/efeitos adversos , Humanos , Incidência , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/efeitos adversos , Paquistão/epidemiologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Muscle Nerve ; 59(6): 643-649, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30702153

RESUMO

INTRODUCTION: To improve diagnostic accuracy, in this study we compared prebiopsy clinical parameters with subsequent pathological confirmation of peripheral nerve vasculitis. METHODS: Clinical, laboratory, and neurophysiological parameters were analyzed for consecutive patients referred for nerve biopsy with suspected vasculitis. Patients were assigned pathological categories of definite, probable, possible, or absent vasculitis using validated guidelines. Patients with definite or probable vasculitis were considered to have pathologically confirmed vasculitis. RESULTS: From a cohort of 78 patients, biopsy confirmed vasculitis in 29.5%. Parameters that best differentiated between pathologically confirmed and pathologically unlikely vasculitis were stepwise clinical progression (34.8% vs. 5.6%), the presence of serum anti-myeloperoxidase antibody (28.6% vs. 2.2%) and rheumatoid factor seropositivity (38.1% vs. 10.7%). Pathologically absent vasculitis was frequent in patients with normal (100%) or primarily demyelinating (87.5%) nerve conduction studies. DISCUSSION: Factoring the negative predictors of pathologically confirmed vasculitis into decision-making can reduce the frequency of diagnostically unhelpful nerve biopsies. Muscle Nerve 59:643-649, 2019.


Assuntos
Doenças do Sistema Nervoso Periférico/diagnóstico , Vasculite/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Anticorpos Antinucleares/imunologia , Autoanticorpos/imunologia , Biópsia , Tomada de Decisão Clínica , Crioglobulinemia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/imunologia , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Peroxidase/imunologia , Fator Reumatoide/imunologia , Vasculite/imunologia , Vasculite/patologia , Vasculite/fisiopatologia
18.
Pharm Res ; 36(2): 35, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30617559

RESUMO

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse side effect of cancer chemotherapy that can be life debilitating and cause extreme pain. The multifactorial and poorly understood mechanisms of toxicity have impeded the identification of novel treatment strategies. Computational models of drug neurotoxicity could be implemented in early drug discovery to screen for high-risk compounds and select safer drug candidates for further development. METHODS: Quantitative-structure toxicity relationship (QSTR) models were developed to predict the incidence of PN. A manually curated library of 95 approved drugs were used to develop the model. Molecular descriptors sensitive to the incidence of PN were identified to provide insights into structural modifications to reduce neurotoxicity. The incidence of PN was predicted for 60 antineoplastic drug candidates currently under clinical investigation. RESULTS: The number of aromatic nitrogens was identified as the most important molecular descriptor. The chemical transformation of aromatic nitrogens to carbons reduced the predicted PN incidence of bortezomib from 32.3% to 21.1%. Antineoplastic drug candidates were categorized into three groups (high, medium, low) based on their predicted PN incidence. CONCLUSIONS: QSTR models were developed to link physicochemical descriptors of compounds with PN incidence, which can be utilized during drug candidate selection to reduce neurotoxicity.


Assuntos
Antineoplásicos/efeitos adversos , Desenho de Drogas , Aprendizado de Máquina , Neoplasias/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/diagnóstico , Antineoplásicos/química , Humanos , Incidência , Estrutura Molecular , Redes Neurais (Computação) , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/epidemiologia , Relação Estrutura-Atividade
19.
Pract Neurol ; 19(2): 164-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30530723

RESUMO

Diabetic lumbosacral radiculoplexus neuropathy is a monophasic syndrome of diffuse pain and weakness that typically affects the lower limbs asymmetrically and is often associated with significant weight loss. Recovery can be prolonged and unpredictable. It is a clinical diagnosis and investigations are performed mainly to exclude other causes. Although it is most likely caused by a microvasculitis, there is no evidence to support using intravenous immunoglobulin or any long-term immunosuppression. Pulsed methylprednisolone may help pain if given within 2-3 months of symptom onset.


Assuntos
Neuropatias Diabéticas/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Metilprednisolona/uso terapêutico , Doenças do Sistema Nervoso Periférico/terapia , Neuropatias Diabéticas/diagnóstico , Diagnóstico Diferencial , Humanos , Dor/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Resultado do Tratamento
20.
Muscle Nerve ; 59(3): 342-347, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30549060

RESUMO

INTRODUCTION: We evaluated diagnostic value of sensory tests during recovery from iatrogenic sensory neuropathy using intraoperatively verified nerve injury with subjective symptoms as gold standard. METHODS: Inferior alveolar nerves were monitored neurophysiologically throughout mandibular osteotomy in 19 patients. Sensory disturbance was registered and sensation tested using clinical and quantitative sensory (QST) and neurophysiologic tests postoperatively at 1, 3, 6, and 12 months. Sensitivity, specificity, and predictive values were calculated for all tests. RESULTS: The sensitivity of clinical tests was at best 37%, with 100% specificity, but they lost diagnostic value at chronic stages. Best diagnostic accuracy (highest combination of sensitivity and specificity) at different time points was achieved by combining neurophysiologic and thermal QST or tactile and thermal QST. The single most accurate test was sensory neurography. CONCLUSIONS: Neurography or combinations of neurophysiologic and quantitative tests enables most reliable early and late diagnosis. Clinical sensory examination is inadequate for accurate diagnosis. Muscle Nerve 59:342-347, 2019.


Assuntos
Neuralgia/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Transtornos das Sensações/diagnóstico , Adolescente , Adulto , Eletromiografia , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Masculino , Nervo Mandibular/fisiopatologia , Osteotomia Mandibular/efeitos adversos , Pessoa de Meia-Idade , Neuralgia/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensação , Transtornos das Sensações/complicações , Sensibilidade e Especificidade , Sensação Térmica , Adulto Jovem
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