RESUMO
BACKGROUND: Vasculitic peripheral neuropathy (VPN) is caused by vessel inflammation leading to peripheral nerve injury of acute-to-subacute onset. When VPN occurs in the context of systemic disease it is classified as Systemic Vasculitic Neuropathy (SVN) and as Non-Systemic Vasculitic Neuropathy (NSVN) when restricted to the nerves. OBJECTIVE: This study aimed to compare the clinical characteristics, biopsy findings and disease outcome in patients with VPN. METHODS: Clinical records of adult patients with VPN diagnosed at our institution between June-2002 and June-2019 were retrospectively reviewed. Demographic characteristics, clinical manifestations, nerve conduction studies, nerve biopsies, treatment and clinical evolution were analyzed in all patients with at least 6 months follow-up. RESULTS: Twenty-five patients with VPN were included (SVN, nâ=â10; NSVN, nâ=â15). No significant differences in demographic or clinical features were found between groups. The median delay between symptom onset and nerve biopsy was significantly longer in NSVN patients (10 vs 5.5 months, pâ=â0.009). Erythrocyte sedimentation rate (ESR) values over 20âmm/h were significantly more common in SVN patients (100% vs. 60%, pâ=â0.024). Nerve biopsies showed active lesions more frequently in treatment-naive patients compared to those who had received at least 2 weeks of corticosteroids (92% vs 38%; pâ=â0.03), with a higher proportion of definite VPN cases (92 vs 46%; pâ=â0.04). CONCLUSIONS: Although the clinical manifestations are similar, ESR is an important tool to help distinguish between both conditions. Early nerve biopsy in untreated patients increases diagnostic accuracy, avoiding misdiagnosis.
Assuntos
Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Vasculite/complicações , Vasculite/diagnóstico , Adulto , Idade de Início , Biópsia , Sedimentação Sanguínea , Seguimentos , Humanos , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/patologia , Estudos Retrospectivos , Vasculite/sangue , Vasculite/patologiaAssuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico , Biomarcadores/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/sangue , Paralisia/complicações , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/complicações , Nervo FrênicoAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Paralisia/complicações , Paralisia/sangue , Nervo Frênico , Biomarcadores/sangue , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/sangueRESUMO
The amygdala is an important component of the limbic system that participates in the control of the pain response and modulates the affective-motivational aspect of pain. Neuropathic pain is a serious public health problem and has a strong affective-motivational component that makes it difficult to treat. The central (CeA), basolateral (BLA) and lateral (LA) nuclei of the amygdala are involved in the processing and regulation of chronic pain. However, the roles of these nuclei in the maintenance of neuropathic pain, anxiety and depression remain unclear. Thus, the main objective of this study was to investigate the role of amygdala subnuclei in the modulation of neuropathic pain, including the affective-motivational axis, in an experimental model of peripheral neuropathy. The specific goals were as follows: (1) To evaluate the nociceptive responses and the patterns of activation of the CeA, BLA and LA in neuropathic rats; and (2) To evaluate the effect of inactivating the amygdala nuclei on the nociceptive response, anxiety and depressive behaviors, motor activity, and plasma stress hormones in animals with neuropathic pain. Thus, mechanical hyperalgesia and allodynia, and the pattern of c-Fos staining in the amygdala subnuclei were evaluated in rats with chronic constriction of the sciatic nerve, as well as sham-operated and naïve rats. Once the amygdala subnuclei involved in neuropathic pain response were defined, those subnuclei were pharmacological inactivated. The effect of muscimol inactivation on the nociceptive response (hyperalgesia and allodynia), anxiety (elevated plus-maze), depressive-like behavior (forced swim test), motor activity (open field), and plasma stress hormone levels (corticosterone and adrenocorticotropic hormone) were evaluated in sham-operated and neuropathic animals. The results showed that the anterior and posterior portions of the BLA and the central portion of the CeA are involved in controlling neuropathic pain. The inactivation of these nuclei reversed hyperalgesia, allodynia and depressive-like behavior in animals with peripheral neuropathy. Taken together, our findings improve our understanding of the neurocircuitry involved in persistent pain and the roles of specific amygdala subnuclei in the modulation of neuropathic pain, including the neurocircuitry that processes the affective-motivational component of pain.
Assuntos
Dor Crônica/tratamento farmacológico , Neuralgia/tratamento farmacológico , Dor Nociceptiva/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Hormônio Adrenocorticotrópico/sangue , Animais , Ansiedade/sangue , Ansiedade/tratamento farmacológico , Ansiedade/fisiopatologia , Complexo Nuclear Basolateral da Amígdala/efeitos dos fármacos , Complexo Nuclear Basolateral da Amígdala/fisiopatologia , Núcleo Central da Amígdala/efeitos dos fármacos , Núcleo Central da Amígdala/fisiopatologia , Dor Crônica/fisiopatologia , Corticosterona/sangue , Depressão/sangue , Depressão/tratamento farmacológico , Depressão/fisiopatologia , Humanos , Hiperalgesia/sangue , Hiperalgesia/tratamento farmacológico , Hiperalgesia/fisiopatologia , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Muscimol/administração & dosagem , Neuralgia/sangue , Neuralgia/fisiopatologia , Neurônios/efeitos dos fármacos , Neurônios/patologia , Dor Nociceptiva/sangue , Dor Nociceptiva/fisiopatologia , Medição da Dor , Limiar da Dor , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/fisiopatologia , Ratos , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/fisiopatologiaRESUMO
The development of diabetic peripheral neuropathy (DPN) is always followed by changes in vascular endothelial cells that are related to the reactivity of the homocysteine (Hcy) sulfhydryl group. In this meta-analysis, we investigated the association of Hcy with the pathogenesis and progression of DPN. We screened the Embase, Ovid, PubMed, Web of Science, Wangfang, and China National Knowledge Infrastructure databases. All analyses were performed by using the STATA software, version 12.0 (StataCorp, College Station, TX, USA) and the Comprehensive Meta-analysis 2.0 software (Biostatic Inc., Englewood, NJ, USA). The standardized mean difference (SMD) and 95% confidence interval (95%CI) were further calculated. The electronic literature search identified six articles that included 603 patients with DPN and 687 healthy controls. The pooled SMD of those six studies revealed that increased serum levels of Hcy may be correlated with DPN (SMD = 1.23, 95%CI: 1.09-1.36, P < 0.001). Subgroup analysis according to ethnicity indicated that high serum Hcy levels might be an important risk factor for DPN in both Asian and Caucasian populations (Asians: SMD = 0.62, 95%CI: 0.45-0.79, P < 0.001; Caucasians: SMD = 2.32, 95%CI: 2.10-2.55, P < 0.001; respectively). Elevated serum levels of Hcy indicate the risk of development of DPN in patients, suggesting that Hcy levels could be used as a marker for new therapeutic approaches to DPN.
Assuntos
Diabetes Mellitus/sangue , Neuropatias Diabéticas/sangue , Homocisteína/sangue , Doenças do Sistema Nervoso Periférico/sangue , Idoso , Povo Asiático , Biomarcadores/sangue , Estudos de Casos e Controles , China , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População BrancaRESUMO
Low affinity anti-GM1 IgM-antibodies are part of the normal repertoire of human plasma antibodies (Mizutamari et al.: J Neuroimmunol 50:215-220, 1994), a fact that is against the pathological role proposed for them in autoimmune diseases. Here we present evidence that these low affinity IgM-antibodies are devoid of complement-mediated lytic activity to GM1-liposomes, suggesting that they should not be considered harmful. In contrast to the absence in normal individuals, in the plasma of a patient with sensory polyneuropathy we detected high affinity anti-GM1 IgM-antibodies. Concomitant with the presence of these high affinity anti-GM1 IgM-antibodies, the patient plasma is capable of producing complement-mediated lysis of GM1-liposomes. These results suggest that an increase in the affinity of the naturally existing anti-GM1 antibodies could be the trigger that switches them from non-harmful to pathological.
Assuntos
Gangliosídeo G(M1)/imunologia , Imunoglobulina M/sangue , Doenças do Sistema Nervoso Periférico/imunologia , Adulto , Cromatografia de Afinidade , Cromatografia em Camada Fina , Proteínas do Sistema Complemento/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina M/imunologia , Lipossomos , Doenças do Sistema Nervoso Periférico/sangueRESUMO
The nutritional status of a group of patients with epidemic neuropathy (EN) was reevaluated after a one-year follow-up to observe the changes occurred and to assess their relationship with the individual clinical evolution. 71 patients (40 men and 31 women) were examined. 28 had optic epidemic neuropathy and 43 mixed epidemic neuropathy. Vitamins thiamine, niacin, A and E were determined and the values were compared with those of risk 21 days later. There was an improvement of these indicators after 21 days as a response to the treatment, and an increase one year later of the percentage of individuals deficient in or situated at the margin of thiamine and niacin, which reflects a nutritional unbalance without an apparent association with the clinical evolution that showed a trend towards the recovery of the patients. This disassociation between the clinics and the nutritional and vitamin status suggest that the pathogeny of the EN may be connected with non-nutritional factors. The deficiency found in the nutritional vitamin state could anticipate a worsening of the clinical picture and/or the appearance of clinical manifestations corresponding to deficiency diseases.
Assuntos
Avaliação Nutricional , Estado Nutricional , Doenças do Sistema Nervoso Periférico/sangue , Adulto , Análise de Variância , Biomarcadores/sangue , Convalescença , Cuba/epidemiologia , Surtos de Doenças , Jejum/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/epidemiologia , Fatores de TempoRESUMO
The immune response of a group of patients with epidemical neuropathy and of controls was studied by the immunoblotting technique against proteins of the Coxsackie virus and the proteins of slow effect isolated in our laboratory. 13 sera of patients with epidemical neuropathy and 9 sera of controls were studied. Of the 13 sera studied, 8 (61.5%) recognized protein VPI and 2 sera (15.3%) protein VP0 of the strain 47.93. Of the 9 controls studied, 4 (44.4%) recognized protein VPI and 3 (33.3%) protein VP0 only. With the antigen prepared from the slow effect strain it was obtained a specific signal in 5 (38.5%) sera of patients and in 2 sera (22.5%) of controls. It should be stressed that in this last case the protein observed had a molecular weight of 41,300 D, and that its size was smaller than that of the preceding protein detected against the strain 47.93 was of 45,000 D.
Assuntos
Anticorpos Antivirais/sangue , Infecções por Coxsackievirus/imunologia , Surtos de Doenças , Enterovirus/imunologia , Doenças do Nervo Óptico/imunologia , Doenças do Sistema Nervoso Periférico/imunologia , Proteínas Virais/imunologia , Animais , Especificidade de Anticorpos , Western Blotting , Chlorocebus aethiops , Infecções por Coxsackievirus/epidemiologia , Infecções por Coxsackievirus/virologia , Cuba/epidemiologia , Enterovirus/classificação , Enterovirus/isolamento & purificação , Humanos , Peso Molecular , Doenças do Nervo Óptico/sangue , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/virologia , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/virologia , Coelhos , Estudos Soroepidemiológicos , Células Vero , Proteínas Virais/químicaRESUMO
This is a cross-sectional study with a randomized choice of individuals aiming at studying the validity of the Brazilian biological exposure limits applied to lead level in the blood (PbB) and delta-aminolevulinic acid in the urine (ALAU), which are 60 micrograms/dl and 10 mg/g.creat., respectively. For this purpose, twenty workers, whose PbB and ALAU values have been below these limits over the past two years, were selected at random at a battery production plant in the State of S. Paulo, Brazil. The workers were submitted to a peripheral nerve conduction study. The results were compared with those obtained for workers of a control group also chosen at random. The lead workers showed a decrease in the velocity conduction of the radial nerves. Comparing this group with a randomized control group, a significant difference was observed (p-value = 0.0067). The results suggest that the Brazilian biological exposure limits above should be rearranged.
Assuntos
Intoxicação por Chumbo/sangue , Doenças Profissionais/sangue , Doenças Profissionais/induzido quimicamente , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Adulto , Estudos de Casos e Controles , Humanos , Intoxicação por Chumbo/fisiopatologia , Intoxicação por Chumbo/prevenção & controle , Masculino , Concentração Máxima Permitida , Condução Nervosa , Doenças Profissionais/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologiaRESUMO
Three pediatric patients with Cuban epidemic neuropathy were studied. Cerebrospinal fluid and sera were simultaneously obtained. Albumin and IgG were quantified by immunodifusion. Albumin quotient and local synthesis of IgG were calculated by Reibert/Felgenhauer formula. A patient with optic neuritis had a dysfunction of the blood-cerebrospinal fluid barrier. All the group had local synthesis of IgG.