A deceiving case of paraplegia

Marinucci, Claudia; Zardo, Federica; Diella, Francesco Arcangelo; Cocito, Dario; Ciancio, Alessia; Porta, Massimo; Zanone, Maria M.

doi:10.1007/s11739-019-02059-7

Cited by 1 publication

(10 citation statements)

References 24 publications

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“… 12 , 43 , 44 Severe peripheral neuropathy, although uncommon, is also described. 8 , 18 , 43 Our study confirms the high prevalence of axonal neuropathy both in CG+and CG‐ HCV‐positive patients, strengthen by the dimension of the cohort examined compared to previous studies. 7 , 8 …”

Section: Discussionsupporting

confidence: 86%

“…HCV‐related neuropathies include symmetrical axonal sensorimotor neuropathy, accounting for over 50% of cases, distal symmetric painful small‐fibre neuropathy with predominantly sensory features, mononeuritis multiplex, pure motor polyneuropathy or, rarely, demyelinating and autonomic neuropathies 12,43,44 . Severe peripheral neuropathy, although uncommon, is also described 8,18,43 . Our study confirms the high prevalence of axonal neuropathy both in CG+and CG‐ HCV‐positive patients, strengthen by the dimension of the cohort examined compared to previous studies 7,8 …”

Section: Discussionsupporting

confidence: 85%

“… 36 , 50 In line with this recommendation, our report strengthens the indications for early antiviral therapy, independently of the severity of liver disease, on the basis of the risk of developing serious extrahepatic complications, including neuropathy, with a potentially rapidly progressive course. 18,19 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…5 Two case reports of greatly improved neuropathy after diagnosis and eradication of hitherto ignored HCV infection are suggestive of favourable outcomes of DAA therapy on this complication. 18,19 In the present study, we aimed to assess the prevalence of peripheral neuropathy associated with HCV-infection with and without cryoglobulinemia, and to evaluate prospectively the effects of HCV eradication by DAAs, using a global assessment by standard nerve conduction studies, neurological examination, together with validated questionnaires exploring neurological motor and sensory symptoms, disability and quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Peripheral neuropathy after viral eradication with direct‐acting antivirals in chronic HCV hepatitis: A prospective study

Zanone

Marinucci

Ciancio

et al. 2021

Liver International

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Background HCV‐related extra‐hepatic complications include peripheral neuropathies, with important prevalence and impact. A recent metanalysis of previous intervention trials concluded for insufficient data to support evidence‐based treatments for this complication. In this longitudinal study, we assessed for the first time prevalence and outcome of neuropathy in a cohort of patients with chronic HCV, before and after direct‐acting antiviral agent (DAA) treatment. Method Ninety‐four patients (mean age 58.5 ± 9.9, infection duration 22.2 ± 6.3 years) without systemic and metabolic diseases, underwent neurological examination and electroneurography studies before (T0) and 10.4 ± 1.7 months after the end of DAA therapy (T1), and cryoglobulins (CG) assessment. Muscle strength was evaluated by Medical Research Council (MRC) score; neuropathic pain, sensory function, disability, quality of life were assessed by validated questionnaires (DN4, NPSI, SSS, INCAT and Euro‐QoL). Results At T0, sensory‐motor neuropathy was detected in 22 patients (23%), reflexes were depressed in 32 (34%) with no association with infection duration, viral load, age, CG. Neuropathic pain (DN4 ≥4) was present in 37 patients (39%). At T1, out of the 22 patients with altered electroneurography, 3 had died or developed HCC, 4 showed normal electroneurography, and nerve amplitude parameters tended to improve in the whole group. Only 11 patients (12%) had depressed reflexes and 10 (11%) DN4 ≥4 (P < .05 compared to T0). Scores for MRC, questionnaires and Euro‐QoL improved significantly (P < .05). Conclusion Our study confirms the high prevalence of clinical and subclinical peripheral sensory‐motor neuropathy in patients with HCV infection and indicates improvement after eradication by DAA. These results support the need for larger intervention studies.

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