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.
Adolescent ; Adult ; Arsenic ; analysis ; toxicity ; Cross-Sectional Studies ; Dietary Exposure ; adverse effects ; Dose-Response Relationship, Drug ; Drinking Water ; adverse effects ; chemistry ; Female ; Groundwater ; chemistry ; Humans ; Male ; Middle Aged ; Myanmar ; epidemiology ; Peripheral Nervous System Diseases ; chemically induced ; epidemiology ; physiopathology ; Sensation Disorders ; chemically induced ; epidemiology ; physiopathology ; Water Pollutants, Chemical ; analysis ; toxicity ; Young Adult

OBJECTIVETo compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus.

METHODSSixty patients were randomly divided into an acupuncture group (31 cases) and a medication group (29 cases). Patients in the two groups received basic treatment to control blood sugar within a safe range. On this basis, patients in the acupuncture group were treated with acupuncture at Geshu (BL 17), Weiwanxiashu (EX-B 3), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36), Taixi (KI 3), ashi points, etc. Patients in the medication group were treated with intravenous administration of lipoic acid (0.6 g) and alprostadil (10 mg). The treatment was given once a day, 10 days for a course of treatment; there was an interval of 2 days between courses, and totally 3 courses were given. The score of peripheral neuropathy of diabetes mellitus, the change of nerve conduction: velocity and clinical efficacy before and after treatment in the two groups were observed.

RESULTSAfter treatment, the score of peripheral neuropathy was significantly reduced in the two groups (both P < 0.05), which was more significant in the acupuncture group (P < 0.05). After treatment, the sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of median nerve and common peroneal nerve were significantly increased in the two groups (all P < 0.05). Compared between two groups, the SNCV and MNCV of common peroneal nerve in the acupuncture group were significantly superior to those in the medication group (both P < 0.05); the MNCV of median nerve in the acupuncture group was significantly superior to that in the medication group (P < 0.05); the SNCV of median nerve in the acupuncture group was not significantly different from that in the medication group (P > 0.05). The total effective rate was 83.9% (26/31) in the acupuncture group, which was significantly superior to 62.1% (18/29) in the medication group (P < 0.05).

CONCLUSIONAcupuncture and conventional medication both have satisfied effects for distal symmetric multiple peripheral neuropathy of diabetes mellitus, and acupuncture is superior to medication on improving clinical signs of sensory disorder, reflection disturbance and muscle weakness, nerve conduction and clinical curative effect.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Neuropathies ; etiology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Peripheral Nerves ; physiopathology ; Peripheral Nervous System Diseases ; etiology ; physiopathology ; therapy

Cryoglobulinemia ; physiopathology ; Humans ; Male ; Middle Aged ; Peripheral Nervous System Diseases ; diagnosis ; etiology ; Serologic Tests ; Syphilis ; diagnosis

OBJECTIVETo study the nerve electromyogram results by analysing the pathological characters of 4 cases diagnosed as peripheral neuropathy caused by n-hexane and arsenic.

METHODSThe nerve electromyogram examination and pathology data of 4 patients, who had been diagnosed as toxic chemicals peripheral neuropathy, were studied retrospectively.

RESULTSTwo patients in this group were exposed to n-hexane, their nerve electromyogram examinations and biopsy pathology of superficial peroneal nerve indicated the peripheral neuropathy was mainly manifests the lesion of medullary sheath. Another two patients were exposed to arsenic, their nerve electromyogram examinations showed axonal degeneration associated with demyelination, and their biopsy pathology showed the peripheral neuropathy was mainly axonal degeneration.

CONCLUSIONAxonal degeneration and demyelination always coexist in peripheral neuropathy caused by chemicals.

Arsenic Poisoning ; pathology ; physiopathology ; Female ; Hexanes ; poisoning ; Humans ; Male ; Middle Aged ; Peripheral Nervous System Diseases ; chemically induced ; pathology ; physiopathology ; Retrospective Studies ; Young Adult

OBJECTIVETo observe the peripheral neurotoxicity of 1-bromopropane (1-BP) by developing an animal model of peripheral neuropathy through oral administration of 1-BP.

METHODSForty male Wistar rats were randomly and equally divided into low-dose group (200 mg/kg), medium-dose group (400 mg/kg), high-dose group (800 mg/kg), and control group. The rats in the low-dose, medium-dose, and high-dose groups were orally given 1-BP (dissolved in corn oil), while the rats in the control group were orally given an equal volume of corn oil. The oral administration (0.2 ml/100 g BW) was performed once per day, 5 days per week, for 16 consecutive weeks. Neurobehavioral indices including gait score, hindlimb grip strength, and hindlimb landing foot splay were recorded periodically. Hematological and biochemical parameters were also measured during and after 1-BP exposure.

RESULTSThe gait scores were significantly higher in the high-dose group (after 8 ∼ 16 weeks of 1-BP exposure), medium-dose group (after 14 ∼ 16 weeks of 1-BP exposure), and low-dose group (after 15 ∼ 16 weeks of 1-BP exposure) than in the control group (P < 0.05, P < 0.01). Compared with the control group, the high-dose group showed significantly decreased hindlimb grip strength after 9, 12, and 14 weeks of 1-BP exposure (P < 0.05, P < 0.01), with the hindlimbs paralyzed after 16 weeks of 1-BP exposure. After 16 weeks of 1-BP exposure, the hindlimb grip strengths of rats in the medium-dose and low-dose groups were decreased to 72.6% and 91.2% of the control value (P < 0.01, P < 0.05). Compared with the control group, the high-dose group showed significantly increased hindlimb landing foot splay after 12, 14, and 16 weeks of 1-BP exposure, and the medium-dose group showed significantly increased hindlimb landing foot splay after 14 and 16 weeks of 1-BP exposure (P < 0.05, P < 0.01). The high-dose and medium-dose groups showed significantly higher serum alanine aminotransferase (ALT) activity than the control group after 8 weeks of 1-BP exposure, and so did the low-dose group after 16 weeks of 1-BP exposure (P < 0.01).

CONCLUSIONThe nervous system is sensitive to the toxic effect of 1-BP, and 1-BP exposure can induce peripheral neuropathy in rats.

Animals ; Disease Models, Animal ; Hydrocarbons, Brominated ; administration & dosage ; toxicity ; Male ; Peripheral Nervous System Diseases ; chemically induced ; physiopathology ; Rats ; Rats, Wistar

OBJECTIVETo investigate the intervention of Naoxintong and mecobalamin on electrophysiological changes in diabetic peripheral neuropathy (DPN) of different Chinese medicine (CM) syndrome types.

METHODSAccording to syndrome differentiation, 180 patients with DPN were classified as five syndrome types. And they were treated with Naoxintong (Group A), mecobalamin (Group B), and Naoxintong + mecobalamin (Group C). Four weeks was taken as one therapeutic course, and totally three courses. Their efficacies were assessed using clinical scoring, electrophysiological examinations, and ultrasonic examinations of the blood vessel inner diameter.

RESULTS(1) The motor nerve conduction velocity was obviously slowed down in the Gan-Shen deficiency syndrome (P<0.01). F-wave latency was obviously prolonged in the Gan-Shen deficiency syndrome and yang deficiency blood stasis syndrome (P<0.01). The skin sympathetic reflex latency was obviously prolonged in the qi deficiency blood stasis syndrome and phlegm stagnation collateral obstruction syndrome (P<0.01). (2) Statistical difference existed in the three groups of qi deficiency blood stasis syndrome (chi2 = 7.112, P<0.05) and Gan-Shen deficiency syndrome (chi2 =6.667, P<0.05). Of them, the total effective rate of qi deficiency blood stasis syndrome was 87.5% and the markedly effective rate 43.8% in Group A (P<0.05). The total effective rate of Gan-Shen deficiency syndrome was 100.0% and the markedly effective rate 50.0% in Group B (P<0.05). The total effective rate of qi deficiency blood stasis syndrome, yin deficiency blood stasis syndrome, phlegm stagnation collateral obstruction syndrome, yang deficiency blood stasis syndrome, and Gan-Shen deficiency syndrome was respectively 92.9%, 83.3%, 81.8%, 81.8%, and 75.0% in Group C. (3) Naoxintong and mecobalamin had some improvement of motor and sensory conduction of each CM syndrome type (P<0.05). Mecobalamin showed obvious effect on the skin sympathetic reflection (P<0.05). The nerve electrophysiological index of each syndrome types as well as the diameter of arteriae tibialis anterior could be improved in Group C (P<0.05).

CONCLUSIONSNaoxintong gained better effect in treatment of DPN patients of qi deficiency blood stasis syndrome by syndrome typing. Naoxintong combined with mecobalamin could be helpful for ameliorating DPN patients of each syndrome.

Adult ; Diabetic Neuropathies ; diagnosis ; drug therapy ; physiopathology ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Electrophysiological Phenomena ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Peripheral Nervous System Diseases ; diagnosis ; drug therapy ; physiopathology ; Phytotherapy ; Vitamin B 12 ; analogs & derivatives ; therapeutic use

OBJECTIVE: To study the characteristics of forensic identification cases involved with peripheral nerve injury, and to discuss how to apply the clinical information, forensic examination and neurophysiological testing. METHODS: One hundred and fifty-eight cases which were diagnosed peripheral nerve injury in clinic, were collected. Then the individual characteristics, injuries, identification results, exaggeration or camouflage were analysed. RESULTS: The male, the unemployed, and the young and middle-aged were common in our cases. The main reasons of "peripheral nerve injury" were traffic accidents and sharp injuries. Most wounded parts were in limbs. Also the exaggeration and camouflage accounted for a considerable proportion in our cases. CONCLUSION The forensic identification of "peripheral nerve injury" cases should be evaluated with clinical information, forensic examination and electrophysiological testing comprehensively.
Accidents, Traffic ; Adolescent ; Adult ; Age Distribution ; Disability Evaluation ; Electromyography ; Electrophysiology ; Female ; Forensic Medicine ; Humans ; Male ; Middle Aged ; Neural Conduction/physiology* ; Peripheral Nerve Injuries ; Peripheral Nerves/physiopathology* ; Peripheral Nervous System Diseases/physiopathology* ; Retrospective Studies ; Trauma Severity Indices ; Wounds, Nonpenetrating/physiopathology* ; Young Adult

BACKGROUNDInvolvement of peripheral nerves in dermatomyositis (DM) and polymyositis (PM) is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy.

METHODSThe data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients (118 patients with DM and 68 with PM) were retrospectively analyzed. Nerve conduction studies (NCSs) of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously.

RESULTSThere were 71 (38.2%) patients with abnormal NCS findings, 37 (19.9%) with pure motor involvement (decreased compound muscle action potential, CMAP), and 34 (18.3%) with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 (7.5%) had polyneuropathy, 1 (0.5%) had multiple mononeuropathy, 16 (8.6%) had carpal tunnel syndrome (CTS), 1 (0.5%) had trigeminal sensory neuropathy, 1 (0.5%) had ulnar sensory neuropathy, and 1 (0.5%) had brachial plexus involvement. The prevalence of malignant disease (3/34, 8.8%), other connective tissue diseases (CTDs) (7/34, 20.6%) and diabetes (6/34, 17.6%) was significantly greater in DM/PM patients with peripheral neuropathy (chi(2) = 15.855, P = 0.000) compared with DM/PM patients without involvement of peripheral nerves (5/115, 4.3% and 7/115, 6.1%, respectively).

CONCLUSIONSPeripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Connective Tissue Diseases ; complications ; Dermatomyositis ; complications ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Neural Conduction ; Peripheral Nervous System Diseases ; etiology ; Polymyositis ; complications ; physiopathology ; Retrospective Studies

OBJECTIVETo review the literature on the use of brain imaging, including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), magnetic resonance spectroscopy (MRS) and voxel-based morphometry (VBM) in investigation of the activity in diverse brain regions that creates and modulates chronic neuropathic pain.

DATA SOURCESEnglish literatures from January 1, 2000 to July 31, 2007 that examined human brain activity in chronic neuropathic pain were accessed through MEDLINE/CD ROM, using PET, fMRI, VBM, MRS and receptor binding.

STUDY SELECTIONPublished articles about the application of fMRI, PET, VBM, MRS and chronic neuropathic pain were selected.

DATA EXTRACTIONData were mainly extracted from 40 representative articles as the research basis.

RESULTSThe PET studies suggested that spontaneous neuropathic pain is associated with changes in thalamic activity. Both PET and fMRI have been used to investigate the substrate of allodynia. The VBM demonstrated that brain structural changes are involved in chronic neuropathic pain, which is not seen in a matched control group. However, the results obtained had a large variety, which may be due to different pain etiology, pain distribution, lesion tomography, symptoms and stimulation procedures.

CONCLUSIONSApplication of the techniques of brain imaging plays a very important role in the study of structural and functional reorganization in patients with neuropathic pain. However, a unique "pain matrix" has not been defined. Future studies should be conducted using a prospective longitudinal research design, which would guarantee the control for many confounding factors.

Brain ; pathology ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Pain ; pathology ; physiopathology ; Peripheral Nervous System Diseases ; pathology ; physiopathology ; Positron-Emission Tomography ; Receptors, Dopamine ; metabolism ; Receptors, Opioid ; metabolism

Peripheral nerve impairment is a common complication in surgery, which repair relates directly to the recovery of motor function and sensory function. Clinical researchers always do nerve sutrure using microsurgical technique and adjuvant treatment to improve peripheral nerve regeneration. Western medicine used usually of adjuvant drugs, such as neurotrophic factors, are limited by their defects in clinical application. Traditional Chinese medicine classifies peripheral nerve impair as paralysis and arthromyodynia, considers that it is the result of defects of meridian and vessels, QI and blood, bones and muscles. So, drugs used usually are QI invigorating herbs, blood circulation promoting herbs for unblocking collaterals, and nourishing herbs, including astragali, hedysari, ginkgo leaf, angelica, danshen root, paeoniae radix, epimedium, chuanxiong, and common basic formulas, such as Buyang Huanwu decoction, Huangqi Guizhi Wuwu decoction, Huoxue Kangyuan decoction, compound radix hedysari, etc. To be ready for further study and development, we review the traditional Chinese medicine and formulas in this article.
Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Medicine, Chinese Traditional ; Nerve Regeneration ; drug effects ; Peripheral Nervous System Diseases ; drug therapy ; physiopathology