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Burns : Journal of the International... Jun 2017Peripheral neuropathy is the most frequent disabling neuromuscular complication of burns. However, the insidious and progressive onset of burn neuropathy makes it often... (Review)
Review
Peripheral neuropathy is the most frequent disabling neuromuscular complication of burns. However, the insidious and progressive onset of burn neuropathy makes it often undiagnosed or overlooked. In our study, we reviewed the current studies on the burn-related peripheral neuropathy to summarize the morbidity, mechanism, detecting method and management of peripheral neuropathy in burn patients. Of the 1533 burn patients included in our study, 98 cases (6.39%) were presented with peripheral neuropathy. Thermal and electrical burns were the most common etiologies. Surgical procedures, especially nerve decompression, showed good effect on functional recovery of both acute and delayed peripheral neuropathy in burn patients. It is noteworthy that, for early detection and prevention of peripheral neuropathy, electrodiagnostic examinations should be performed on burn patients independent of symptoms. Still, the underlying mechanisms of burn-related peripheral neuropathy remain to be clarified.
Topics: Action Potentials; Burns; Complex Regional Pain Syndromes; Conservative Treatment; Decompression, Surgical; Electromyography; Humans; Nerve Compression Syndromes; Neural Conduction; Peripheral Nervous System Diseases
PubMed: 28347546
DOI: 10.1016/j.burns.2016.08.003 -
Lancet (London, England)The autonomic neuropathies are a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibres are selectively targeted. Autonomic... (Review)
Review
The autonomic neuropathies are a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibres are selectively targeted. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Diabetes is the most common cause of autonomic neuropathy in more developed countries. Autonomic neuropathies can also occur as a result of amyloid deposition, after acute infection, as part of a paraneoplastic syndrome, and after exposure to neurotoxins including therapeutic drugs. Certain antibodies (eg, anti-Hu and those directed against neuronal nicotinic acetylcholine receptor) are associated with autonomic signs and symptoms. There are several familial autonomic neuropathies with autosomal dominant, autosomal recessive, or X-linked patterns of inheritance. Autonomic dysfunction can occur in association with specific infections. The availability of sensitive and reproducible measures of autonomic function has improved physicians' ability to diagnose these disorders.
Topics: Amyloidosis; Autonomic Nervous System Diseases; Diabetic Neuropathies; Humans; Peripheral Nervous System Diseases
PubMed: 15811460
DOI: 10.1016/S0140-6736(05)74815-7 -
British Medical Journal Feb 1970
Review
Topics: Arsenic Poisoning; Deficiency Diseases; Humans; Isoniazid; Lead Poisoning; Metabolic Diseases; Neoplasms; Nitrofurantoin; Peripheral Nervous System Diseases; Polyradiculopathy
PubMed: 4313649
DOI: 10.1136/bmj.1.5692.349 -
The Lancet. Neurology Oct 2013Why is peripheral neuropathy common but mild in many mitochondrial disorders, and why is it, in some cases, the predominant or only manifestation? Although this question... (Review)
Review
Why is peripheral neuropathy common but mild in many mitochondrial disorders, and why is it, in some cases, the predominant or only manifestation? Although this question remains largely unanswered, recent advances in cellular and molecular biology have begun to clarify the importance of mitochondrial functioning and distribution in the peripheral nerve. Mutations in proteins involved in mitochondrial dynamics (ie, fusion and fission) frequently result in a Charcot-Marie-Tooth phenotype. Peripheral neuropathies with different phenotypic presentations occur in mitochondrial diseases associated with abnormalities in mitochondrial DNA replication and maintenance, or associated with defects in mitochondrial respiratory chain complex V. Our knowledge of mitochondrial disorders is rapidly growing as new nuclear genes are identified and new phenotypes described. Early diagnosis of mitochondrial disorders, essential to provide appropriate genetic counselling, has become crucial in a few treatable conditions. Recognising and diagnosing an underlying mitochondrial defect in patients presenting with peripheral neuropathy is therefore of paramount importance.
Topics: Hereditary Sensory and Motor Neuropathy; Humans; Mitochondrial Diseases; Peripheral Nervous System Diseases
PubMed: 24050734
DOI: 10.1016/S1474-4422(13)70158-3 -
JAMA Oncology May 2019
Topics: Antineoplastic Agents; Humans; Neuralgia; Peripheral Nervous System Diseases
PubMed: 30816956
DOI: 10.1001/jamaoncol.2018.6771 -
The American Journal of Medicine Sep 2018Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and... (Review)
Review
Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and disability. The clinical presentation of neuropathy is diverse, with possible symptoms including weakness, sensory abnormalities, and autonomic dysfunction. Accordingly, the primary care clinician must be comfortable using the neurologic examination-including the assessment of motor function, multiple sensory modalities, and deep tendon reflexes-to recognize and characterize neuropathy. Although the causes of peripheral neuropathy are numerous and diverse, careful review of the medical and family history coupled with limited, select laboratory testing can often efficiently lead to an etiologic diagnosis. This review offers an approach for evaluating suspected neuropathy in the primary care setting. It will describe the most common causes, suggest an evidence-based workup to aid in diagnosis, and highlight recent evidence that allows for selection of symptomatic treatment of patients with neuropathy.
Topics: Analgesics; Botulinum Toxins; Diagnosis, Differential; Electric Stimulation Therapy; Humans; Medical History Taking; Neuralgia; Neurologic Examination; Peripheral Nervous System Diseases; Primary Health Care
PubMed: 29408540
DOI: 10.1016/j.amjmed.2017.12.042 -
Physical Medicine and Rehabilitation... May 2003The element of time is a crucial factor in the electrodiagnostic presentation of PN. The characteristic changes seen in various neuropathies evolve over time. If testing... (Review)
Review
The element of time is a crucial factor in the electrodiagnostic presentation of PN. The characteristic changes seen in various neuropathies evolve over time. If testing is performed very early in the course of the disease, abnormalities may not yet be present, in part, because the range of normal values for NCS parameters is broad. In addition, if the process is asymmetric, the affected nerves may not be sampled. Very late in the course of the disease, a multifocal process may appear diffuse and symmetric as the areas of focal involvement coalesce. A primarily, demyelinating process may begin to demonstrate secondary axonal involvement. In very severe neuropathies, it may become difficult to evoke any NCS responses to characterize the neuropathy. It is essential to place the electrodiagnostic findings within the context of the clinical progression to avoid drawing erroneous conclusions. Sometimes, the true nature of the neuropathy is clear only after sequential testing. The etiologic diagnoses of acquired polyneuropathy are vast. A well-crafted electrodiagnostic evaluation can categorize neuropathies into more specific diagnostic groups by identifying the descriptive diagnosis, significantly narrowing the list of possible etiologic diagnoses. Electrodiagnostic testing, which always starts with a pertinent history and physical examination, should always be viewed as a continuation and quantification of the physical examination. Only by knowing the extent and pattern of the clinical involvement is it possible to formulate a thorough electrodiagnostic evaluation. This knowledge is especially important in cases in which the presentation is multifocal, because the neuropathy can be missed entirely if the affected nerves are not evaluated. When evaluating a neuropathy, there are three important questions to answer: (1) Is the process diffuse or multifocal? (2) Is it demyelinating or axonal? (3) Does it predominantly involve the motor or sensory nerves? By assessing the neuropathy along these three axes, the large number of possible etiologic diagnoses becomes much more manageable.
Topics: Diagnosis, Differential; Electrodiagnosis; Humans; Medical History Taking; Neural Conduction; Peripheral Nervous System Diseases; Physical Examination
PubMed: 12795521
DOI: 10.1016/s1047-9651(02)00118-3 -
Brain and Nerve = Shinkei Kenkyu No... Nov 2013The typical clinical manifestation of vasculitic peripheral neuropathy is sensory-dominant multiple mononeuropathy, although it can progress to distal-dominant... (Review)
Review
The typical clinical manifestation of vasculitic peripheral neuropathy is sensory-dominant multiple mononeuropathy, although it can progress to distal-dominant sensorimotor polyneuropathy. It is painful in most cases. Peripheral nerves may be the most prone to produce symptoms of the vasculitis. Nerve conduction studies show reduced amplitude of M wave or sensory nerve action potential, which depends on the degree of injury of a nerve examined. Wallerian degeneration can cause pseudo-conduction block in the acute stage and temporal dispersion in the chronic stage. However, a definite diagnosis requires histological confirmation. Combined biopsy of the sural nerve and the peroneus brevis muscle can be performed by a single incision. Skin biopsy can also be performed. To increase the diagnostic yield, biopsy specimens are prepared in different manners to observe as many cross sections as possible: frozen unfixed, formalin-fixed paraffin-embedded, and glutaraldehyde-fixed epon embedded specimens, as well as teased fiber preparation of a nerve. Vasculitic peripheral neuropathy usually results from small-vessel vasculitis. There are still controversies regarding the classification of vasculitides. Differential diagnosis of vasculitis includes infection and lymphoma. Delayed diagnosis and treatment of neuropathy result in the impairment of ADL and QOL. Recovery from axonal degeneration usually takes time and is not always possible. Treatment includes corticosteroid, cyclophosphamide, and intravenous immunoglobulin administration; however, the intensity of treatment depends on the disease activity of vasculitis.
Topics: Biopsy; Diagnosis, Differential; Humans; Necrosis; Peripheral Nervous System Diseases; Skin; Vasculitis
PubMed: 24200608
DOI: No ID Found -
Cancer Investigation Jun 2003While cancer remains an important public health concern, novel and enhanced treatment modalities have increased the length of survival of individuals diagnosed with the... (Review)
Review
While cancer remains an important public health concern, novel and enhanced treatment modalities have increased the length of survival of individuals diagnosed with the disease. The treatment of most cancers requires the use of chemotherapeutic agents to affect cure, maintain control of the disease, or provide palliation of symptoms. Although the use of chemotherapeutic agents can serve to prolong life, such agents are associated with significant side effects. Increasing clinical evidence suggests treatment of cancer with neurotoxic agents results in some degree of peripheral neuropathy. Specific drug categories implicated in the development of peripheral neuropathy are the plant alkaloids, interferons, antimitotics, taxanes, and platinum-based compounds. Drug-induced peripheral neuropathy is sensory, dose-related and cumulative and is usually delayed, appearing weeks after initiation of therapy. The number of individuals at risk for the development of chemotherapy-induced neuropathy is expected to increase proportionately with clinical protocols utilizing higher or more frequent dosing. As advanced cancer treatments and clinical trials can result in extending the lives of individuals affected by cancer, long-term functional deficits resulting from life-saving treatments must now be addressed. As such, peripheral neuropathy has emerged as an important consequence of cancer therapy.
Topics: Antineoplastic Agents; Humans; Incidence; Motor Activity; Neoplasms; Peripheral Nervous System Diseases
PubMed: 12901290
DOI: 10.1081/cnv-120018236 -
Handbook of Clinical Neurology 2013Peripheral neuropathy is an important factor of disability in the elderly, which is significant now that up to 20% of the population is older than 60 years in... (Review)
Review
Peripheral neuropathy is an important factor of disability in the elderly, which is significant now that up to 20% of the population is older than 60 years in industrialized countries. Potentially treatable neuropathies including primary inflammatory polyneuropathies and systemic disorders, especially vasculitic neuropathies, are as common in this age group as in younger patients. Neuropathies associated with diabetes, malignancy, and monoclonal gammopathies are even more common in these patients. It is thus essential to identify the causes of these neuropathies in this group of patients and treat them whenever feasible.
Topics: Aging; Humans; Peripheral Nervous System Diseases
PubMed: 23931816
DOI: 10.1016/B978-0-444-52902-2.00046-1