جستجوی مقالات مرتبط با کلیدواژه « peripheral neuropathy » در نشریات گروه « پزشکی »

Diabetic foot syndrome is becoming increasingly common in India with a prevalence ranging from 24.9% to 49%. Diabetic foot syndrome patients have an increased likelihood of developing ulcers in their feet. Accordingly, this study evaluates the influence of photobiomodulation on altered plantar pressure distribution and ankle biomechanics in individuals with diabetic foot syndrome. 

A total of 20 diabetic foot syndrome patients with an absence of 10 g monofilament in one out of six sites at the plantar surface of feet, a biothesiometer for vibration perception threshold of >20 V, and diminished or absent ankle reflexes were included. The evaluation of ankle biomechanics was performed by SIMI motion analysis. In addition, the plantar pressure distribution was measured by the WinTrack pressure platform at baseline and the end of 10 sessions. They were treated with scanning mode on the foot plantar surface and probe laser at the popliteal fossa region for three sessions per week, for ten sessions. 

Plantar pressure parameters were significantly improved (P<0.01) and ankle biomechanics (P<0.01) after the intervention, respectively, except for no significant difference in the total contact area and ankle midstance kinematics.

Photobiomodulation therapy can be an effective treatment for improving foot plantar pressure redistribution and ankle biomechanics in individuals with diabetic foot syndrome.

In this study, we intend to evaluate the occurrence of small fiber neuropathy in patients with irritable bowel syndrome (IBS).

Small fiber neuropathy (SFN) is a sensory neuropathy that results from the degeneration of small Aδ and unmyelinated C fibers. SFN manifests positive symptoms, such as tingling, burning, prickling, and aching, and negative symptoms, including numbness, tightness, and coldness. The SFN coexistence with other comorbidities (e.g., fibromyalgia, inflammatory bowel disease, celiac disease) has been reported in previous studies.

We conducted a cross-sectional study to assess the coexistence of SFN and IBS. Forty-two IBS patients and forty-three healthy individuals were asked to complete the Michigan Neuropathy Screening Instrument (MNSI) questionnaire. Results greater than three (>3) were considered positive. Participants with positive MNSI questionnaire results were examined for any neuropathy signs according to the Utah Early Neuropathy Scale (UENS) examination. The participants with positive results for the questionnaire and examination were checked for the sural and the superficial peroneal nerve conduction study (NCS). Normal NCS represented intact large fibers and the diagnosis of SFN.

Ten participants, 7 (16.7 %) in the IBS group and 3 (6.9 %) in the healthy group, had positive results for the questionnaire. Four participants were positive for the examination, with normal NCS, and were classified as SFN-positive. All four SFN diagnoses were from the IBS group. No one in the healthy group was diagnosed with SFN. We could find a significant statistical difference (p<0.05) between the IBS and healthy groups regarding the prevalence of SFN diagnosis.

The co-occurrence of SFN and IBS suggests the possibility of a generalized neuropathy syndrome characterized by widespread neuronal impairment. Thus, any peripheral neuropathy symptom in IBS patients (and potentially other chronic pain disorders) should be evaluated for SFN since timely diagnosis and proper treatment result in a better quality of life for the patients.

 Distal peripheral neuropathy (DPN) is a prevalent issue among patients with type 2 diabetes mellitus. Despite the widespread use of low-level laser therapy (LLLT) and limited use of Tecar therapy in physiotherapy for diabetics, the synergistic effect of these two interventions in a long-term follow-up has not yet been determined.

 This study aimed to compare the effects of Tecar therapy and LLLT separately and simultaneously over a 3-month follow-up period on clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN.

 In this double-blind, randomized clinical trial, forty-five individuals with type 2 diabetes (30 women and 15 men) with DPN were randomly assigned to three groups of 15 people: Tecar-on + laser-sham, Tecar-on + laser-on, and laser-on + Tecar-sham. The patients received ten treatment sessions and were followed up for 3-months after the last session. Health-related quality of life was assessed using the WHOQOL-BREF Questionnaire, while clinical symptoms, including pain (measured with a Visual Analog Scale), functional balance (evaluated with the timed-up and go test), and neuropathy symptoms (assessed with the Michigan Questionnaire) were also recorded.

 Inter-group comparison after ten sessions revealed that the Tecar-on + laser-sham and Tecar-on + laser-on groups exhibited significant improvement in neuropathy symptoms compared to the laser-on + Tecar-sham group. Even after the 3-month follow-up, these two groups showed lasting improvement in all variables compared to the laser-on + Tecar-sham group (P < 0.05). The Tecar-on + laser-on group demonstrated a more enduring significant effect on pain scores (P = 0.035) compared to the Tecar-on + laser-sham group after the 3-month follow-up. In intra-group comparison, all three groups showed significant improvement in clinical symptoms and health-related quality of life after ten treatment sessions compared to before treatment (P < 0.05). Moreover, after the 3-month follow-up, both the Tecar-on + laser-sham group and the Tecar-on + laser-on group demonstrated a more lasting significant effect in all variables compared to before treatment (P < 0.05). For the laser-on + Tecar-sham group, a more durable improvement in health-related quality of life (P = 0.000) and neuropathy symptoms (P = 0.011) was reported after the 3-month follow-up compared to before treatment.

 Although all three groups exhibited significant improvement in clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN after ten treatment sessions, the synergistic use of Tecar therapy and LLLT after a long-term follow-up period could lead to more durable therapeutic effects in improving these outcomes for individuals with diabetes.

Diaphragm paralysis may be either idiopathic or associated with several medical conditions including viral and bacterial infection. The association of phrenic nerve palsy with viral infections is rare but well-appreciated in several case reports. Neuropathy, both central and peripheral, is a common neurological consequence of COVID-19. Here, we describe a case of diaphragm paralysis in a woman who was admitted to the hospital because of COVID-19 pneumonia. Post-COVID-19 unilateral paralyzed diaphragm was diagnosed with a chest X-ray for her and the disorder was attributed to COVID-19 because no other etiology was found to be associated. So far, phrenic neuropathy and diaphragmatic paralysis in a COVID-19-affected patient have not been reported from Iran.

Peripheral neuropathy is a common side effect of chemotherapeutic agents. This study aimed to assess the impact of hydroalcoholic extract from Capparis spinosa fruit on mechanical allodynia and heat hyperalgesia induced by vincristine.

Vincristine (0.1 mg/kg/day, intraperitoneally) was used to induce peripheral neuropathy in rats for 2 weeks. The rats received treatment with the hydroalcoholic extract of Capparis spinosa fruit (100, 200, and 400 mg/kg, orally) or pregabalin (20 mg/kg, orally) for 2 weeks. Assessments of thermal and mechanical hyperalgesia were conducted using the hot plate, open field, footprint, grip strength, and von Frey hair tests. To investigate the roles of opioid and serotonergic pathways in anti-nociceptive and locomotor activities, naloxone (1 mg/kg) and cyproheptadine (5 mg/kg) were administered in conjunction with the extract.

Two weeks post vincristine administration, there was a significant decrease in thermal and mechanical nociceptive thresholds, muscle strength, and locomotor activity in rats compared to untreated groups. In all tests, pregabalin mitigated vincristine’s effects; notably, the Capparis spinosa extract at a dose of 400 mg/kg significantly reduced neuropathic behavioral changes compared to animals that received vincristine. The efficacy of the extract at the 400 mg/kg dose was diminished by naloxone in the von Frey filament test (P < 0.01), hot plate test (P < 0.05), and grip strength test (P < 0.001). Additionally, cyproheptadine reversed the extract’s effect in the grip strength (P < 0.0001) and von Frey filament tests (P < 0.01).

The findings suggest that the hydroalcoholic extract of Capparis spinosa fruit may counteract vincristine-induced neuropathic pain through opioidergic and serotonergic pathways. The extract’s beneficial effects are likely due to its flavonoid and phenolic compound content.

Taxane-induced peripheral neuropathy (TIPN) is a dose-limiting adverse effect of chemotherapy without anyspecific treatment. The aim of this paper is to evaluate the effects of natural products and supplements onTIPN. PubMed, Google Scholar and Web of Science databases were searched through August 2022 regardingTIPN and effects of natural products and supplement therapy. Data consists of preclinical studies, randomizedcontrolled trials and case reports. After screening of 230 papers, we found 13 relevant animal and human studiesregarding possible benefits of vitamin E, glutamine, omega-3, acetyl-L-carnitine and group of B vitamins onTIPN. Results demonstrated that vitamin E can be helpful on prevention and duration of TIPN. Glutamineand B vitamins showed hopeful results on reducing pain sensation. Omega-3 also shows promising resultson incidence of TIPN. However, acetyl-L-carnitine might develop and worsen neuropathy. Although somesupplements revealed promising effects on prevention and treatment of TIPN, researches are still limited andwe need further long-term large sample size trials to confirm clinical efficacy of these supplements.

Organophosphates are among the most common causes of poisoning worldwide—responsible for 3 million poisoning and 200000 deaths every year. Nearly 15% of people who are poisoned die. This cross-sectional toxicological/clinical study aimed to investigate the prevalence and influential factors in the incidence of delayed peripheral neuropathy and intermediate syndrome in acute poisoning with organophosphorus toxins. The study was conducted in Loghman Hakim Hospital, Tehran City, Iran, from 2017 to 2020.

The study data were obtained from the patients’ records during follow-up. Data included demographic information (age, sex, etc.), vital signs, muscarinic, nicotinic, and neurological symptoms at admission, atropine therapy status, and pralidoxime intake status. Post-discharge complications were obtained, and patients’ Electromyography (EMG) and Nerve Conduction Velocity (NCV) results were recorded and evaluated during hospitalization and follow-up. Statistical analysis was performed using SPSS software, version 22.

Of 63 studied patients, 61.9% were female. The Mean±SD age of the patients was 31.90±13.128 years. Male patients were significantly (P<0.010) older than female ones. The most common muscarinic symptoms were nausea and vomiting (73.2%), diarrhea (34.92%), and abdominal pain (33.33%). Regarding the nicotinic symptoms, sweating (30.16%) and fasciculation (19.05%) were the commonest. Neurological complications were less common; seizures were observed in 3 cases (4.76%) and coma in 2 cases (3.17%). Most patients (79.4%) received pralidoxime with atropine. The Mean±SD days of treatment with atropine and pralidoxime were 5.51±3.52 and 4.06±4.62 days, respectively. Only one death was recorded. The results of the initial EMG-NCV test on the second day of hospitalization showed abnormalities in 4 patients (6.3%), indicating the presence of the intermediate syndrome.

The results of the EMG-NCV tests at our patients’ follow-up (30 days) showed no abnormalities. Hence no cases of delayed neuropathy were seen. During hospitalization, one patient had flaccid paralysis and showed significant impairment on the EMG-NCV test (P<0.01).

Taxane-induced pain is a disabling condition. This trial was conducted to assess the effects of melatonin on preventing paclitaxel-associated acute and chronic pain or decreasing its severity in patients with breast cancer.

This randomized, double-blind, placebo-controlled clinical trial was conducted on breast cancer women who received weekly paclitaxel (80 mg/m2) with or without trastuzumab after using doxorubicin + cyclophosphamide. The intervention group randomly received oral melatonin (10 mg/day) or placebo, which started from the first night of chemotherapy and continued through the planned 12 weeks of chemotherapy. The level of arthralgia-myalgia as acute pain was assessed every day in both groups using the Brief Pain Inventory (BPI). The Douleur Neuropathique 4 questionnaire (DN4) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0 were used to measure chemotherapy-induced peripheral neuropathy as chronic pain.

Seventeen patients were enrolled in each group randomly. The incidence of neuropathy according to a DN4 score ≥ 4 was significantly lower in the melatonin group versus the placebo group at week 12 compared to baseline (5 vs 11, P-value= 0.039). In addition, the mean neuropathy severity was significantly lower in the melatonin group over time (β= -0.051, P-value= 0.01). However, there were no significant differences in the mean worst and least pain scores over the twelve cycles of treatment between arms (P-value= 0.633 and 0.34, respectively).

Co-administration of melatonin in women with breast cancer decreased the incidence of severe paclitaxel-associated neuropathy but melatonin was not effective against acute pain.

Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to erroneous diagnosis and delayed treatment resulting in irreversible neurological sequelae as is described in our case.

A 65-year-old hypertensive female, with a 7-year history of BPD presented with decreased oral intake since 5-7 days, followed by altered sensorium. Neurological examination revealed coarse tremors in bilateral upper and lower limbs with spasticity, hyperreflexia, bilateral knee clonus. Twenty-five days earlier, she was prescribed Lithium carbonate. On evaluation she was found to have chronic kidney disease. Serum lithium levels came out to be 1.18 mg/dL (borderline high). After ruling out other differentials, a diagnosis of lithium toxicity was considered and she underwent two sessions of hemodialysis (HD) leading to significant improvement in sensorium; however, the patient had persistent dysarthria, difficulty in walking and proximal myopathy predominantly in the lower limbs. Nerve conduction studies confirmed the presence of axonal neuropathy. These findings of peripheral neuropathy (both sensory and motor) were suggestive of SILENT (syndrome of irreversible lithium-effectuated neurotoxicity).

Unintended lithium toxicity can occur even at therapeutic levels especially in the elderlies owing to its narrow therapeutic window, complex pharmacokinetics and numerous drug interactions. Lithium can result in irreversible neurotoxicity including SILENT; therefore, a high level of suspicion is required to prevent such permanent disability.

Peripheral neuropathy is one of the major complications of type II diabetesmellitus. Lower limb proprioceptive impairments due to neuropathy can lead to balance disorders in these patients.

The present study aimed to investigate postural stability and neuropathic changes following ankle proprioceptive training in type II diabetic patients with moderate neuropathy.

The present study was conducted on24 type II diabetic patients with moderate neuropathy (9 females and 15 males) aged 40-65 years (with a mean age of 57.25 years). The treatment consisted of ankle proprioceptive training by the balance board and rocker for10 consecutive days. Balance indices, including Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Medial-Lateral Stability Index (MLSI), were measured withBiodex system before and after the treatment, as well as two weeks after treatment in two conditions: condition1: Eyes open, head straight, without using trunk, pelvis, thigh, and knee constrained orthosis. Condition 2: Eyes closed, head back (hyperextension), with using trunk, pelvis, thigh, and knee constrained orthosis. Plate-basedBiodexstability was fixed at levels 6 and 8 for condition1 and level 8 for condition 2. The severity of neuropathy was assessed using Valk and Michiganquestionnaires, as well as light touch sensation. The analysis of variance with repeated measure was used to evaluate alterations in the stability of patients. Furthermore, the correlation of neuropathic changes and stability parameters were assessed by the Pearson correlation coefficients.

Significant improvements were observed in OSI inall tests of condition 1 (Biodex Balance System (BBS) at level 8 (P=0.001) and level 6 (P=0.017), as well as test conditions 2 (level 8; P=0.004). After the treatment, at stability level 8, a significant improvement in the mean values of postural sways inthe Anterior-Posterior (AP) direction demonstrated that the ankle strategy was improved in the patients. After the treatment, the scores of the Valk (P=0.02) and Michigan (P=0.001) questionnaires were significantly decreased. After two weeks of follow-up,the observed improvement was maintained in the mean values of balance indices (OSI, APSI) and neuropathy due to treatment.

As evidenced by the obtained results, 10 sessions of targeted ankle proprioceptive training improved stability, neuropathy, and light touch sensation of the foot in type II diabetic patients with moderate neuropathy. Foot somatosensory information is one of the most important causes of balance alterations in these patients.

The most reported form of statin induced pain is myalgia, conversely peripheral neuropathy is a rare side effect. We report a patient who received rosuvastatin for hypercholesterolemia and experienced episodes of pain in both hands during the night. Rosuvastatin was stopped and atorvastatin was replaced. Re-introduction with another statin resulted in a more severe form of the similar adverse effect after 4 months. This is a rare adverse effect of a extensively prescribed class of drug. Physicians should be aware of the possibility of peripheral neuropathy symptoms in patients on statin therapy.

Diabetes is one of the most common causes of peripheral neuropathy. There are no known cures for diabetic neuropathy. Pentoxifylline could theoretically be a beneficial treatment for diabetic sensory neuropathy, but there is not enough evidence to prove its effect. The aim of this study was to investigate the effect of pentoxifylline on distal diabetic neuropathy.

In this randomized double‑blinded placebo‑controlled trial, 60 patients with diabetic peripheral neuropathy were randomized into two groups. The intervention group received Vitamin B1 (100 mg twice daily) and pentoxifylline (400 mg twice daily) and control group received Vitamin B1 (100 mg twice daily) and placebo (twice daily) for 2 months. Before and after the intervention, the symptoms of distal polyneuropathy were recorded by the Michigan Neuropathy Screening Instrument. ANCOVA, Paired t‑test, unpaired t‑test, Chi‑square, and Fisher’s exact test were used to compare changes in symptoms and sign of distal polyneuropathy.

The mean age of patients was 57.1 ± 8.02 years. There was no significant difference between the two groups in regard to the baseline variables. Blood pressure, body mass index, and blood glucose did not change significantly during the study. In the pentoxifylline group, the symptoms of peripheral neuropathy were significantly improved, in comparison with placebo group (P = 0.042).

This study showed pentoxifylline could be effective in reducing the symptoms of distal diabetic neuropathy.

A 43-year-old male presented with diplopia and right sixth-nerve palsy. Brain magnetic resonance imaging (MRI) demonstrated a lesion in the right periventricular area. High-dose corticosteroid pulse therapy did not resolve the symptom. After one month, his diplopia progressed and he developed weakness of the left lower limb. Detailed examination revealed left sixth-nerve palsy, dropped foot, waddling gait, atrophy of the gluteal muscles and mild atrophy and weakness of the right upper limb. Neurological examination supported evidence of multiple cranial nerve palsies along with asymmetrical peripheral neuropathy. Electrodiagnostic studies were compatible with a mononeuritis multiplex. Rheumatologic evaluations were normal. Malignancy work-up were normal, except for some insignificant lymph nodes. Bone marrow aspiration and biopsy were normal. The second brain MRI detected multiple homogenous enhancing lesions in the right periventricular area.The result of stereotactic biopsy and immunohistochemistry staining demonstrated primary B-cell CNS lymphoma (PCNSL). Mononeuritis multiplex has not been reported as a paraneoplastic manifestation of PCNSL yet. In other words, it is not clear whether involvement of the peripheral nervous system in our patient is a paraneoplastic manifestation of PCNSL or a coincidence of PCNSL and hematologic lymphoma presenting with peripheral vasculitic neuropathy. It is recommendedthat future studies focus more on symptoms associated with PCNSL to recognize the exact relationship between PCNSL and peripheral neuropathy.