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Fulltext Thyrotoxic neuropathy- an under diagnosed condition

Sahni V, Gupta N, Anuradha S, Tatke M, Kar P

Med J Malaysia, 2007 Mar;62(1):76-7.
PMID: 17682580

Many neurological diseases like myopathy, periodic paralysis, ophthalmoplegia, and myasthenia gravis are known associations of thyrotoxicosis. However the association of neuropathy with thyrotoxicosis is not frequently recognized. First described by Charcot in 1889, thyrotoxic neuropathy or 'Basedow's Paraplegia' is a rarely reported entity. We describe here a case of a young woman with subacute distal neuropathy as the presenting manifestation of thyrotoxicosis. The neuropathy improved on antithyroid treatment. A careful literature search leads us to believe that peripheral neuropathy in thyrotoxicosis is under recognised. Thyroid function tests can be helpful in the diagnosis of this treatable neuropathy and should be included in the routine work up.

Matched MeSH terms: Peripheral Nerves/physiopathology
Systemic lupus erythematosus may have an early effect on peripheral nerve function in patients without clinical or electrophysiological neuropathy: comparison with age- and gender-matched controls

Fong SY, Raja J, Wong KT, Goh KJ

Rheumatol Int, 2021 02;41(2):355-360.
PMID: 32488429 DOI: 10.1007/s00296-020-04610-8

Asymptomatic electrophysiological peripheral neuropathy is described in systemic lupus erythematosus (SLE) patients. To determine if SLE could have an even earlier effect on peripheral nerve function even before the development of electrophysiological abnormalities, we compared nerve conduction studies (NCS) of SLE patients without electrophysiological or clinical peripheral neuropathy with healthy controls. Consecutive SLE patients without clinical neuropathy (or other known causes of neuropathy) underwent sensory and motor NCS of all four limbs. Results of 61 patients without electrophysiological criteria of neuropathy were compared with age- and gender-matched controls. Although still within the laboratory's range of normal values, significant differences were found in several NCS parameters between patients and controls. SLE patients had lower amplitudes for ulnar, fibular, and tibial compound muscle action potentials (CMAP) and sural sensory nerve action potentials (SNAP); slower conduction velocities for median, ulnar, and fibular motor nerves, and median, ulnar and sural sensory nerves. SLE patients also had longer minimum F-wave latencies for median, ulnar, fibular, and tibial nerves. H reflexes were more often absent in patients. Correlations were found between the number of disease relapses and motor conduction velocities of the fibular and tibial nerves. SLE may have early effect on peripheral nerve function in patients even before they develop electrophysiological or clinical neuropathy.

Matched MeSH terms: Peripheral Nerves/physiopathology
Bickerstaff's brainstem encephalitis with overlapping Guillain-Barré syndrome: Usefulness of sequential nerve conduction studies

Fong CY, Aung HWW, Khairani A, Gan CS, Shahrizaila N, Goh KJ

Brain Dev, 2018 Jun;40(6):507-511.
PMID: 29459060 DOI: 10.1016/j.braindev.2018.02.001

Bickerstaff's brainstem encephalitis (BBE) is a rare immune-mediated disorder characterized by ophthalmoplegia, ataxia and disturbance of consciousness, which may overlap with Guillain-Barré syndrome (GBS) if there is additional limb weakness. We report a 7-month-old boy presented with ophthalmoplegia followed by a rapidly ascending paralysis of all four limbs and disturbance of consciousness. The initial impression was BBE with overlapping GBS. This was supported by sequential nerve conduction study (NCS) findings compatible with an acute inflammatory demyelinating polyneuropathy (AIDP). He received intravenous pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis with complete clinical recovery after 6 weeks of illness and improved NCS findings from week 16. This is the first case of paediatric BBE with overlapping GBS with an AIDP subtype of GBS. It expands the clinical spectrum of this condition in children. Our case highlights the importance of sequential NCS in paediatric BBE with overlapping GBS for accurate electrophysiological diagnosis and prognosis particularly if the first NCS findings are not informative.

Matched MeSH terms: Peripheral Nerves/physiopathology*
Large fiber peripheral neuropathy in systemic sclerosis: A prospective study using clinical and electrophysiological definition

Raja J, Balaikerisnan T, Ramanaidu LP, Goh KJ

Int J Rheum Dis, 2021 Mar;24(3):347-354.
PMID: 33432774 DOI: 10.1111/1756-185X.14042

AIM: The reported prevalence of peripheral neuropathy in systemic sclerosis (SSc) is variable between 0.01% to 28%, probably due to differences in sample size, study design and population. Our aim is to determine the prevalence of large fiber peripheral neuropathy in SSc and to identify any contributing factors.
METHOD: A prospective cross-sectional study of 60 SSc patients were evaluated for large fiber neuropathy using the modified clinical Total Neuropathy Score (cTNS) and nerve conduction study (NCS) of the upper and lower limbs. A combination of clinical (cTNS score ≥ 2) and NCS criteria (≥2 abnormal nerves including 1 sural [symmetrical polyneuropathy] and NCS abnormalities consistent with individual nerves/nerve roots [focal neuropathy]) was used to diagnose peripheral neuropathy.
RESULTS: The majority had limited cutaneous subset (75%). Mean age was 55.73 (SD ± 13.04) years and mean disease duration was 8.61 (SD ± 8.09) years. Twenty-two (36.7%) had combined clinical and NCS criteria for peripheral neuropathy, 14 (23.3%) with symmetrical polyneuropathy and 8 (13.3%) with focal neuropathy. Symmetrical polyneuropathy patients had significantly lower hemoglobin levels (11.2 vs. 12.35 g/L; P = .047). Serum vitamin B12 levels were normal, therefore excluding vitamin B12 deficiency. No other associations were found for both polyneuropathy and focal neuropathy with demography, co-morbid diseases and SSc disease factors such as Raynaud's phenomenon and modified Rodnan skin score.
CONCLUSION: Large fiber neuropathy is common in SSc patients, which could contribute to non-lethal burden in SSc with sensory loss and muscle weakness. Apart from lower hemoglobin in polyneuropathy, there were no associations with disease-specific features or co-morbid diseases.

Matched MeSH terms: Peripheral Nerves/physiopathology*
A biomarker for exposure to organophosphate and carbamate pesticides

Lubis SH, El Sersi M, Hussein SH, Sakian NI, Salleh R, Rafai J, et al.

Asia Pac J Public Health, 2008 Oct;20 Suppl:162-5.
PMID: 19533876

A cross sectional study was conducted to investigate the effects of pesticide exposure (organophosphate and carbamate) using nerve conductive velocity, current perception threshold (CPT). Cluster random sampling was employed to recruit 64 paddy farmers and 22 fishermen in June 2006. The duration of pesticide exposure was between (5-20) years. The CPT values were measured using Neurometer CPT/Eagle, on the index finger and the great toe with three neuroselective frequencies range (2000, 250, and 5 Hz). The results showed that at the three different frequencies, the CPT values were significantly elevated among farmers on both the medial and peroneal nerves (P < .002). The measurement of CPT can be used as a biomarker to determine and monitor the effects of organophosphate and carbamate exposure among workers who may have been exposed.

Matched MeSH terms: Peripheral Nerves/physiopathology