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1.
Neurology ; 93(18): 788-792, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31659130

RESUMO

Nodoparanodopathy is a recent concept in the field of peripheral neuropathy, corresponding to peripheral nerve disorders stemming from an autoimmune attack directed and limited to the nodal region. This concept was identified using modern techniques of electrophysiology, immunology, and pathology (including electron microscopy). We present here what we believe to be the earlier well-documented case of nodoparanodopathy in the medical literature, based on an article written by Samuel Gilbert Webber (1838-1926) in 1884.


Assuntos
Doenças Autoimunes do Sistema Nervoso/história , Doenças do Sistema Nervoso Periférico/história , Doenças Autoimunes do Sistema Nervoso/patologia , Doenças Autoimunes do Sistema Nervoso/fisiopatologia , História do Século XIX , Humanos , Neurologia/história , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Nós Neurofibrosos/patologia
2.
Postgrad Med ; 131(7): 546-549, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31483199

RESUMO

Objectives: To identify the cognitive and functional deficits in a well-characterized group of patients with vasculitis of the nervous system. Methods: Sixty-seven patients diagnosed with Central Nervous System (CNS) or Peripheral nervous System (PNS) vasculitis over a 14-year period were retrospectively identified. Data on clinical presentation, laboratory, radiographic and tissue biopsy investigations, and treatment were collated. Cognitive, functional and quality of life evaluation assessments were performed in 31 patients who agreed to participate and included Addenbrooke's Cognitive Examination-revised (ACE-R), Nottingham Extended Activities of Daily Living (NEADL) and EQ-5D-3L quality of life questionnaires. Results: CNS vasculitis patients exhibited cognitive impairment, with a mean ACE-R score of 74/100 (standard deviation (SD) 16). NEADL and EQ-5D-3L scores were in the impaired range at 41/66 (SD 21) and 57/81 (SD 22), respectively. Patients with just PNS vasculitis exhibited fewer cognitive deficits with ACE-R and NEADL scores of 87 (SD 8) and 46 (SD 16) respectively. EQ-5D-3L score was in the impaired range of 65 (SD 22). Conclusions: Vasculitis of the nervous system and, in particular, CNS vasculitis causes cognitive impairment and deficits in functional ability. Such patients should be targeted for cognitive rehabilitation.


Assuntos
Disfunção Cognitiva/psicologia , Doenças do Sistema Nervoso Periférico/psicologia , Vasculite do Sistema Nervoso Central/psicologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Estudos Transversais , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/fisiopatologia , Arterite de Células Gigantes/psicologia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/fisiopatologia , Granulomatose com Poliangiite/psicologia , Nível de Saúde , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Vasculite/complicações , Vasculite/tratamento farmacológico , Vasculite/fisiopatologia , Vasculite/psicologia , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/tratamento farmacológico , Vasculite do Sistema Nervoso Central/fisiopatologia , Adulto Jovem
4.
Minerva Med ; 110(5): 455-463, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31368292

RESUMO

Peripheral neuropathies are frequently encountered in clinical practice and are associated with a major impairment in quality of life. However, their management remains poor, and current therapies are often burdened with major side effects and can present poor efficacy on pain and functionality. Therefore, it has been suggested that the combination of two or more different drugs may improve analgesic efficacy and reduce side effects. Tricortin® 1000 is formulated with 12 mg of Brain cortex phospholipid liposomes + 1000 µg of Cyanocobalamin injectable solution (PL+CNCbl) for intramuscular use and is indicated in the treatment of poly-algo-neuropathic syndromes. This combination exerts a marked neurotrophic action by promoting the synthesis of endogenous phospholipids; moreover, the peculiar formulation optimizes the delivery of CNCbl which has analgesic and neurotrophic action. This paper discusses the pharmacotherapy of peripheral neuropathies, including low-back pain, neck pain, postherpetic neuropathy (PHN) and focuses on the fixed dose combination PL+CNCbl clinical efficacy in association with other treatments or in monotherapy.


Assuntos
Analgésicos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Fosfolipídeos/uso terapêutico , Vitamina B 12/uso terapêutico , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Córtex Cerebral/química , Ensaios Clínicos como Assunto , Combinação de Medicamentos , Humanos , Injeções Intramusculares , Lipossomos , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/efeitos adversos , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Fosfolipídeos/administração & dosagem , Fosfolipídeos/efeitos adversos , Vitamina B 12/administração & dosagem , Vitamina B 12/efeitos adversos
5.
Biomed Res Int ; 2019: 2607872, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428631

RESUMO

Mist Antiaris is a herbal decoction for treatment of nervous disorders. Safety and efficacy were evaluated in Sprague-Dawley rats and human patients, respectively. Acute toxicity was assessed by administration of a single 5000 mg/kg oral dose of decoction to a group of six rats. For subchronic toxicity, four groups of six rats each received water (control) or 10, 100, or 200 mg/kg oral doses of decoction daily for eight weeks. Body weight, serum, urine, and hematological profile of the animals in each group were monitored over the period. Effects of treatment on pentobarbital-induced sleeping time and histology of liver, lung, heart, and kidney tissue were assessed at the end of the study. There was no evidence of acute toxicity within 48 hours of the oral dose. Over the 8-week period, body weight increases in Mist Antiaris treatment groups were reduced relative to the control group. There were no significant differences in urine profile, serum biochemistry, hematological parameters, and pentobarbital-induced sleeping time. Tissue histology revealed no differences relative to controls. Assessment of efficacy was by retrospective review of data on patients who presented with peripheral neuropathy. Treatment resulted in 53.7 % of patients reporting complete resolution and 15.7 % showing reduction in neuropathic symptoms. The data demonstrate that there is no toxicity due to subchronic administration of Mist Antiaris in Sprague-Dawley rats. The reduction or resolution of neuropathic symptoms indicated by patents' file data provides evidence to suggest that Mist Antiaris has antineuropathic effects.


Assuntos
Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Preparações de Plantas/farmacologia , Administração Oral , Animais , Peso Corporal , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Humanos , Masculino , Tamanho do Órgão , Doenças do Sistema Nervoso Periférico/metabolismo , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Ratos , Ratos Sprague-Dawley
6.
Endocrinology ; 160(9): 2119-2127, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31318414

RESUMO

Worldwide, the most prevalent metabolic disorder is diabetes mellitus (DM), an important condition that has been widely studied. Diabetic peripheral neuropathy (DPN), a complication that can occur with DM, is associated with pain and can result in foot ulcers and even amputation. DPN treatments are limited and mainly focus on pain management. There is a clear need to develop treatments for DPN at all stages. To make this progress, it is necessary to understand the molecular signaling pathways related to DPN. For this review, we aimed to concentrate on the main signaling cascades that contribute to DPN. In addition, we provide information with regard to treatments that are being explored.


Assuntos
Neuropatias Diabéticas/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Transdução de Sinais/fisiologia , Animais , Neuropatias Diabéticas/fisiopatologia , Dislipidemias/complicações , Glicosilação , Humanos , Fatores de Crescimento Neural/fisiologia , Estresse Oxidativo , Doenças do Sistema Nervoso Periférico/fisiopatologia , Proteína Quinase C/fisiologia
7.
Handb Clin Neurol ; 161: 281-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307606

RESUMO

Neuromyotonic and myokymic discharges are abnormal electrical muscular discharges caused by ectopic discharges from motor axons and represent the hallmarks of peripheral nerve hyperexcitability. Neuromyotonic discharges are specific for peripheral nerve hyperexcitability syndromes, whereas myokymic discharges may occur either focally or in a more generalized fashion in many other peripheral nerve disorders. Isaacs syndrome and Morvan syndrome are rare acquired peripheral nerve hyperexcitability disorders that share common clinical features and are often associated with elevated voltage-gated potassium channel-complex antibodies. Central nervous system symptomatology is more common in Morvan syndrome, which also overlaps with limbic encephalitis. Cramp-fasciculation syndrome, a more common syndrome, may represent a milder form of peripheral nerve hyperexcitability. Peripheral nerve hyperexcitability syndromes should be distinguished from stiff person syndrome, myotonic disorders, and rippling muscle disease. When severe, Isaacs syndrome and Morvan syndrome may be disabling but often respond to membrane-stabilizing drugs and immunomodulatory treatments. The electrophysiologic features of these disorders are described.


Assuntos
Síndrome de Isaacs/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Siringomielia/fisiopatologia , Humanos , Encefalite Límbica/fisiopatologia
8.
Handb Clin Neurol ; 160: 523-540, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277874

RESUMO

Somatosensory evoked potentials (SEPs) have been routinely used over the years to evaluate the somatosensory pathway and thereby supplement the diagnostic process when the history, neurologic examination, and imaging were not fully conclusive. The utilization of SEPs has become more popular in recent years despite the advance of imaging studies such as magnetic resonance imaging (MRI). Although no agreement has been found on the nomenclature and origins of some of the potentials, the most consistently recognized potentials have been used in clinical practice with montages and normative values set by each individual laboratory. The clinical use of SEPs will probably continue to increase as diagnostic and prognostic markers of central and peripheral nervous system disorders and in clinical trials.


Assuntos
Potenciais Somatossensoriais Evocados/fisiologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Humanos , Tempo de Reação/fisiologia
9.
Muscle Nerve ; 60(3): 271-278, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31228263

RESUMO

INTRODUCTION: Use of peripheral nerve ultrasound alongside standard electrodiagnostic tests may help to gain insight into the pathophysiology of peripheral nerve involvement in type 2 spinocerebellar ataxia (SCA2). METHODS: Twenty-seven patients with SCA2 underwent ultrasound cross-sectional area (CSA) measurement of median, ulnar, sural and tibial nerves, and motor (median, ulnar, tibial) and sensory (median, ulnar, radial, sural) nerve conduction studies. RESULTS: Twenty patients had pathologically small-nerve CSAs, suggestive of sensory neuronopathy. In these patients, electrophysiology showed non-length-dependent sensory neuropathy (14 of 20), "possible sensory neuropathy" (1 of 20), or normal findings (5 of 20). Four different patients had length-dependent sensory neuropathy on electrophysiology, and 1 had enlarged nerve CSAs. Regression analysis showed an inverse relationship between ataxia scores and upper limb nerve CSA (P < 0.03). DISCUSSION: Our findings suggest that a majority of patients with SCA2 (74%) have a sensory neuronopathy and this correlates with disability. A minority of patients have findings consistent with axonal neuropathy (18%). Muscle Nerve, 2019.


Assuntos
Nervos Periféricos/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Ataxias Espinocerebelares/fisiopatologia , Extremidade Superior/fisiopatologia , Adulto , Idoso , Ataxia Cerebelar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/metabolismo , Condução Nervosa/fisiologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Transtornos das Sensações/fisiopatologia , Ultrassonografia/métodos
10.
Genes Genomics ; 41(9): 993-1000, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31183681

RESUMO

The peripheral nervous system (PNS) is composed with all nerves extended from the brain and spinal cord, which are the central nervous system to other organs of the body. Dysfunctional peripheral motion resulting from the regressive neuronal axons in the defected PNS leads to several peripheral neuropathies including both inherited and non-inherited disorders. Because of poor understanding of cellular and molecular mechanisms involved in the peripheral neuropathy, there is currently non-targeted treatment of the disorder. Basic researches have paid attention to dissect roles of causative genes, identified from the inherited peripheral neuropathies, in PNS development. However, recent studies focusing on investigation of therapeutic targets have suggested that successful regeneration of the impaired peripheral nerves may be most effective treatment. The regeneration studies have been limited in the rodents system due to some of practical and physiological disadvantages until zebrafish model has emerged as an ideal system. Hence, this review aims to provide a comprehensive overview of the advantages of zebrafish as a model for the peripheral neuropathy researches and to suggest the disease genes-involved potential mechanisms targeting the PNS regeneration that may be demonstrated in zebrafish.


Assuntos
Modelos Animais de Doenças , Doenças do Sistema Nervoso Periférico/genética , Peixe-Zebra/genética , Animais , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Peixe-Zebra/fisiologia , Proteínas de Peixe-Zebra/genética
11.
Gait Posture ; 72: 206-210, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31254773

RESUMO

BACKGROUND: Falls are prevalent among cancer survivors, and neuropathy, a side effect from chemotherapy treatment, is thought to contribute to falls. While falls commonly occur during walking, there is limited information about gait function in cancer survivors with neuropathy. RESEARCH QUESTION: What is the difference between gait speed and gait variability in cancer survivors with and without self-reported neuropathy and healthy controls? METHODS: Seventeen cancer survivors and 12 healthy individuals [age: 53.5 (11.8), gender: 10 females] participated in a single testing session. Cancer survivors were grouped into neuropathy [n = 9; age: 61.9 (6.1); gender: 8 females] and no neuropathy [n = 8; age: 50.75 (14.1); gender: 7 females] based on the self-reported FACT/GOG Neurotoxicity subscale questionnaire. All participants completed two walking trials at their comfortable pace across a 6 m pressure sensitive walkway. A one-way ANOVA with Tukey's post-hoc analysis and effect sizes were used to detect differences in gait speed, step length variability, and step width variability between groups. RESULTS: Although there were no group differences in gait speed, a significant main effect was found for step length variability (p =  0.03, η2 = 0.24) between groups. Step length variability was significantly less in cancer survivors with neuropathy than healthy controls (p = 0.05, d = 1.30). There was a significant main effect for step width variability between groups (p = 0.05, η2 = 0.20). Cancer survivors with neuropathy had significantly greater step width variability than healthy controls (p = 0.04, d = 1.04). SIGNIFICANCE: Cancer survivors with neuropathy display greater step width variability and less step length variability than healthy controls. Gait variability may be a more sensitive marker than gait speed to track mobility in cancer survivors with neuropathy symptoms. Assessing and treating gait function in cancer survivors with neuropathy symptoms may improve everyday ambulation.


Assuntos
Sobreviventes de Câncer , Marcha , Doenças do Sistema Nervoso Periférico/fisiopatologia , Autorrelato , Velocidade de Caminhada , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
Int Rev Neurobiol ; 145: 127-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31208522

RESUMO

Peripheral neuropathy is a common and debilitating complication of diabetes and prediabetes. Recent clinical studies have identified an association between the development of neuropathy and dyslipidemia in prediabetic and diabetic patients. Despite the prevalence of this complication, studies identifying molecular mechanisms that underlie neuropathy progression in prediabetes or diabetes are limited. However, dysfunctional mitochondrial pathways in hereditary neuropathy provide feasible molecular targets for assessing mitochondrial dysfunction in neuropathy associated with prediabetes or diabetes. Recent studies suggest that elevated levels of dietary saturated fatty acids (SFAs) associated with dyslipidemia impair mitochondrial dynamics in sensory neurons by inducing mitochondrial depolarization, compromising mitochondrial bioenergetics, and impairing axonal mitochondrial transport. This causes lower neuronal ATP and apoptosis. Conversely, monounsaturated fatty acids (MUFAs) restore nerve and sensory mitochondrial function. Understanding the mitochondrial pathways that contribute to neuropathy progression in prediabetes and diabetes may provide therapeutic targets for the treatment of this debilitating complication.


Assuntos
Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/fisiopatologia , Transtornos Heredodegenerativos do Sistema Nervoso/fisiopatologia , Dinâmica Mitocondrial/fisiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Animais , Dislipidemias/complicações , Dislipidemias/fisiopatologia , Gânglios Espinais/metabolismo , Transtornos Heredodegenerativos do Sistema Nervoso/complicações , Humanos , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Doenças do Sistema Nervoso Periférico/complicações
13.
BMC Cancer ; 19(1): 414, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046719

RESUMO

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) can affect functional performance and quality of life considerably. Since balance training has proven to enhance physical function, it might be a promising strategy to manage CIPN-induced functional impairments. METHODS: Fifty cancer survivors with persisting CIPN after finishing their treatment were randomly allocated to an intervention (IG) or active control group (CG). The IG did endurance plus balance training, the CG only endurance training (twice weekly over 12 weeks). Pre- and post-assessments included functional performance, cardiorespiratory fitness, vibration sense, and self-reported CIPN symptoms (EORTC QLQ-CIPN20). RESULTS: Intention-to-treat analyses (n = 41) did not reveal a significant group difference (CG minus IG) for sway path in semi-tandem stance after intervention (primary endpoint), adjusted for baseline. However, our per-protocol analysis of 37 patients with training compliance ≥70% revealed: the IG reduced their sway path during semi-tandem stance (- 76 mm, 95% CI -141 - -17; CG: -6 mm, 95% CI -52 - 50), improved the duration standing on one leg on instable surface (11 s, 95% CI 8-17; CG: 0 s, 95%CI 0-5) and reported decreased motor symptoms (-8points, 95% CI -18 - 0; CG: -2points 95% CI -6 - 2). Both groups reported reduced overall- (IG: -10points, 95% CI -17 - -4; CG: -6points, 95% CI -11 - -1) and sensory symptoms (IG: -7points, 95% CI -15 - 0; CG: -7points, 95% CI -15 - 0), while only the CG exhibited objectively better vibration sense (knuckle: 0.8points, 95% CI 0.3-1.3; IG: 0.0points, 95% CI -1.1 - 0.9; patella: 1.0points, 95% CI 0.4-1.6: IG: -0.8points, 95% CI -0.2 - 0.0). Furthermore, maximum power output during cardiopulmonary exercise test increased in both groups (IG and CG: 0.1 W/kg, 95% CI 0.0-0.2), but only the CG improved their jump height (2 cm, 95% CI 0.5-3.5; IG: 1 cm, 95% CI -0.4 - 3.2). CONCLUSION: We suppose that endurance training induced a reduction in sensory symptoms in both groups, while balance training additionally improved patients' functional status. This additional functional effect might reflect the IG's superiority in the CIPN20 motor score. Both exercises provide a clear and relevant benefit for patients with CIPN. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) number: DRKS00005419 , prospectively registered on November 19, 2013.


Assuntos
Antineoplásicos/efeitos adversos , Sobreviventes de Câncer/psicologia , Doenças do Sistema Nervoso Periférico/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aptidão Cardiorrespiratória , Tratamento Farmacológico , Treino Aeróbico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/psicologia , Qualidade de Vida , Resultado do Tratamento
14.
Environ Health Prev Med ; 24(1): 23, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014238

RESUMO

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION: Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.


Assuntos
Arsênico/toxicidade , Exposição Dietética/efeitos adversos , Água Potável/efeitos adversos , Água Potável/química , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Poluentes Químicos da Água/toxicidade , Adolescente , Adulto , Arsênico/análise , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Água Subterrânea/química , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Transtornos das Sensações/induzido quimicamente , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/fisiopatologia , Poluentes Químicos da Água/análise , Adulto Jovem
15.
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
16.
Altern Ther Health Med ; 25(2): 36-41, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30990792

RESUMO

Objectivest: The purpose of this study was to examine the effects of 8 wk of moderate intensity aerobic exercise on vibration perception threshold (VPT) in type 2 diabetic peripheral neuropathy (DPN). Methods: Single blind parallel group randomized controlled trial was done in a tertiary center. Stratified block randomization was used for selecting participants. A total of 87 individuals participated in the study. After final randomization, there were only 47 individuals in the control group and 37 in the study group. The exercise group training was carried out in the range of 40% to 60% of heart rate reserve as an adjunct to this rating of perceived exertion (scale ranging from 6 to 20) before, during, and postexercise. For the control group, standard medical care, education for foot care, and diet (same as the experimental group) were given. Both the groups were assessed at baseline and wk 8. Results: On comparison of results for control and study group using repeated measures of analysis of variance for VPT measures for 3 sites (great toe, medial malleoli, first metatarsal phalanx), there was a significant difference between the 2 groups (df1, df2 = 1,63; F = 8.56; P < .001) for both lower limbs. Conclusions: Aerobic exercises have an augmentative effect on vibratory sensations of the peripheral nerves, which implicates an attenuating effect on DPN in type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Exercício , Doenças do Sistema Nervoso Periférico/fisiopatologia , Sensação/fisiologia , Vibração , Humanos , Percepção , Método Simples-Cego
17.
Gait Posture ; 71: 62-68, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31009918

RESUMO

BACKGROUND: Impairments in central and/or peripheral nervous systems are known to be associated with altered gait; however, the interplay between cognitive function, peripheral sensation, and orbital gait stability remains largely unclear. Elucidating these relationships is expected to provide a clearer understanding of potential fall risk factors across various populations and targets for novel interventions. Many patients diagnosed with cancer are treated with chemotherapy agents known to be neurotoxic to the central and/or peripheral nervous systems that can contribute to movement deficiencies, making this population a novel model to investigate these relationships. RESEARCH QUESTION: The purpose of this exploratory study was to investigate how central and peripheral nervous system impairments associate with orbital stability during single- and dual-task gait. METHODS: Twenty cancer survivors were enrolled and separated into three groups: no prior chemotherapy exposure (CON, n = 6), and prior treatment with chemotherapy and having no/mild chemotherapy-induced peripheral neuropathy (CIPN) symptoms (-CIPN, n = 8) or moderate/severe CIPN symptoms (+CIPN, n = 6). Testing included single- and dual-task (i.e., serial sevens) treadmill walking as well as a computerized test of executive function. Maximum Floquet multipliers were calculated to assess orbital stability during gait. RESULTS: Worse executive function was associated with decreased orbital stability during the dual-task condition in the +CIPN group (Spearman's ρ = 0.94, P = 0.017). Additionally, decreased orbital stability during dual-task gait was observed for the -CIPN group compared to the CON group (ES = 1.96, P = 0.019). SIGNIFICANCE: Executive dysfunction was associated with decreased gait stability during challenging dual-task gait in survivors with sensory symptoms of CIPN. The association between combined central and peripheral nervous system impairments and decreased gait stability in cancer survivors provides a novel demonstration of potential compensatory strategies that accompany deficiencies in these functions. Future work is needed to confirm these relationships and whether they hold in other populations.


Assuntos
Sobreviventes de Câncer , Transtornos Neurológicos da Marcha , Doenças do Sistema Nervoso Periférico , Acidentes por Quedas , Idoso , Teste de Esforço , Feminino , Marcha , Humanos , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Síndromes Neurotóxicas , Sistema Nervoso Periférico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Sobreviventes , Caminhada
18.
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
20.
J Neurol ; 266(6): 1332-1339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30830284

RESUMO

PURPOSE: To examine dorsal root ganglia and proximal nerve segments in patients carrying the Fabry-related GLA-gene variant p.D313Y in comparison to patients with classical Fabry mutations and healthy controls by morphometric and functional magnetic resonance neurography. METHODS: This prospective multicenter study examines the lumbosacral dorsal root ganglia and sciatic nerve in 11 female p.D313Y patients by a standardized magnetic resonance neurography protocol at 3 T. Volumes of dorsal root ganglia L3 to S2, permeability of dorsal root ganglia L5 and S1, and spinal nerve L5 as well as cross-sectional area of the sciatic nerve were assessed and compared to 10 females carrying a classical Fabry mutation and 16 healthy female controls. RESULTS: Compared to healthy controls, dorsal root ganglia volumes of p.D313Y females were enlarged by 53% (L3), 48% (L4), 43% (L5), 57% (S1) (p < 0.001), and 55% (S2) (p < 0.05), but less pronounced compared to females carrying a classical Fabry mutation. Compared to healthy controls, p.D313Y patients showed no changes of dorsal root ganglia vascular permeability, while patients with a classical Fabry mutation showed a distinct decrease (p < 0.05). Sciatic nerve cross-sectional area was mildly increased by 6% in p.D313Y as well as in classical Fabry patients (p < 0.05). CONCLUSIONS: Patients carrying the GLA-gene variant p.D313Y show distinctly enlarged dorsal root ganglia, while vascular permeability remains within normal limits. Overall, these alterations partially share characteristics commonly seen in patients with a mutation causing classical FD. This suggests that p.D313Y causes a potentially treatable condition resembling an early stage of Fabry disease.


Assuntos
Gânglios Espinais/patologia , Doenças do Sistema Nervoso Periférico , Nervo Isquiático/patologia , alfa-Galactosidase/genética , Adulto , Idoso , Permeabilidade Capilar/fisiologia , Doença de Fabry/genética , Feminino , Gânglios Espinais/diagnóstico por imagem , Gânglios Espinais/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Mutação , Doenças do Sistema Nervoso Periférico/genética , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Estudos Prospectivos , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/fisiopatologia , Adulto Jovem
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