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Methylprednisolone May Improve Lumbosacral Radiculoplexus Neuropathy

Published online by Cambridge University Press:  02 December 2014

P. James B. Dyck
Affiliation:
Peripheral Neuropathy Research Laboratory, Mayo Clinic and Mayo, Foundation, Rochester, Minnesota
Jane E. Norell
Affiliation:
Peripheral Neuropathy Research Laboratory, Mayo Clinic and Mayo, Foundation, Rochester, Minnesota
Peter James Dyck
Affiliation:
Peripheral Neuropathy Research Laboratory, Mayo Clinic and Mayo, Foundation, Rochester, Minnesota
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Abstract

Objective:

To report on an open trial of intravenous methylprednisolone (IV MP) in nondiabetic lumbosacral radiculoplexus neuropathy (LSRPN).

Background:

Lumbosacral radiculoplexus neuropathy is a subacute, unilateral or asymmetric syndrome of pain, weakness, and paresthesia of the lower extremity, which is attributed to ischemic injury from microvasculitis in lumbosacral roots, plexus, and nerves.

Methods:

Eleven nondiabetic patients with worsening LSRPN were treated - ten with infusions of IV MP (1 gm/wk) for 8 to 16 weeks and one with an equivalent dosage of oral prednisone. The main endpoints evaluated were: 1) the Neuropathy Impairment Score (NIS), and 2) the Neuropathy Symptoms and Change (NSC) scores.

Results:

The median age of our patients was 67 years, range 49 to 86 years. Seven patients were women. All 11 patients reported improvement during treatment - nine reported marked improvement. The median NIS improved from 42 points (range 9 to 106 points) before treatment, to 20 points (range 5 to 57 points) (p = 0.005) after treatment. Pain was completely resolved in four patients and much improved in seven. The change subscore and the severity subscore of the NSC were statistically significantly improved after treatment. Prior to treatment, all patients had significant weakness with six confined to wheelchairs and four using mechanical devices to aid in ambulation. After treatment, the weakness was markedly improved in nine patients; only one still required a wheelchair and six walked independently (p = 0.03).

Conclusion:

1) In LSRPN, pain and neurological deficits improved (often dramatically) with IVMPtreatment. 2) Although our results should be interpreted with caution since this trial is uncontrolled, IV MP may favorably affect the natural history of LSRPN. 3) The results are sufficiently promising to provide a rationale for prospective, sham controlled, double blind trials.

Résumé:

RÉSUMÉ: Objectif:

De rapporter une étude ouverte sur l'injection intraveineuse de méthylprednisolone (MPIV) chez des sujets non diabétiques présentant une neuropathie du plexus lombo-sacré (NPLS).

Introduction:

La neuropathie lombosacrée est un syndrome douloureux subaigu unilatéral ou asymétrique accompagné de faiblesse et de paresthésies du membre inférieur qui est attribué à une lésion ischémique due à une microvasculite des racines lombosacrées, du plexus et des nerfs.

Méthodes:

Onze patients non diabétiques présentant une NPLS de plus en plus sévère ont été traités - dix au moyen d'infusions (1 gm par semaine) de MPIV pendant 8 à 16 semaines et un au moyen d'une dose équivalente de prednisone orale. Les principaux critères d'évaluation des résultats étaient: 1) le Neuropathy Impairment Score (NIS) et 2) les Neuropathy Symptoms and Change (NSC) scores.

Résultats:

L'âge médian des patients était de 67 ans (écart de 49 à 86 ans). Sept des patients étaient des femmes. Tous les patients ont rapporté une amélioration des symptômes pendant le traitement et cette amélioration était importante chez neuf. Le NIS s'est amélioré de 42 points (écart de 9 à 106 points) avant le traitement, à 20 points (écart de 5 à 57 points) (p = 0.005) après le traitement. La douleur est disparue complètement chez quatre et a été très améliorée chez sept. L'analyse statistique des scores de changement et de sévérité du NSC a montré une amélioration significative après le traitement. Avant le traitement, tous les patients avaient une faiblesse importante et six étaient confinés au fauteuil roulant alors que quatre utilisaient un soutien mécanique pour la marche. Après traitement, la faiblesse était très améliorée chez neuf patients; seulement un utilisait un fauteuil roulant et six marchaient sans aide (p = 0.03).

Conclusions:

1) Dans la NPLS, la douleur et les déficits neurologiques se sont améliorés, souvent de façon dramatique, avec le traitement par la MPIV; 2) bien que nos résultats doivent être interprétés avec prudence étant donné qu'il s'agit d'une étude ouverte, la MPIVpeut influencer favorablement l'histoire naturelle de la NLS; 3) ces résultats sont assez prometteurs pour justifier des études prospectives, à double insu, avec placebo.

Type
Research Article
Copyright
Copyright © The Canadian Journal of Neurological 2001

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