Drug therapy for chronic idiopathic axonal polyneuropathy

Vrancken, Alexander F.J.E.; Schaik, Ivo N. van; Hughes, Richard; Notermans, Nicolette C.

doi:10.1002/14651858.cd003456.pub2

Cited by 9 publications

(5 citation statements)

References 102 publications

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“…Thirty percent of chronic idiopathic axonal polyneuropathy (CIAP) patients experience pain due to neuropathy 4 . No clinical studies have been reported concerning the treatment of neuropathic pain in CIAP patients 5 . Anticonvulsants and antidepressants are the first choice treatments for the reduction of neuropathic pain 6 .…”

Section: Introductionmentioning

confidence: 99%

High Doses of Topical Amitriptyline in Neuropathic Pain: Two Cases and Literature Review

Kopsky¹,

Hesselink²

2011

Pain Practice

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Severe chronic neuropathic pain is a challenge to treat, and due to adverse effects of classical oral medication, optimal and effective dose levels are difficult to reach. Therefore, administration of topical analgesics might be an option, due to reduced adverse effects, and increased patient compliance. The aim of this article is to describe two cases treated effectively with topical amitriptyline 5% and 10%, the highest dosage described to date. The first patient was a 39-year-old man, suffering from severe intractable neuropathic pain in feet and hands, due to diabetes mellitus type II (DM-II). After application of amitriptyline 5% the patient experienced a complete relieve only in the hands, whereas after application of amitriptyline 10%, a total reduction of pain occurred within 20 minutes, lasting the whole day. The second patient was a 57-year-old man, suffering for 10 years from progressive sensory disturbances in both feet and increasing pain due to chronic idiopathic axonal polyneuropathy (CIAP). Amitriptyline 5% cream reduced pain in the toes nearly completely, but this was not the case in the heels. Amitriptyline 10% reduced pain in the feet, however, systemic adverse effects occurred, mainly drowsiness. The patient decided to stop topical treatment because of these adverse effects. These two cases suggest an analgesic dose-response effect of topical amitriptyline in painful neuropathy. Systemic adverse effects should be taken into account.

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Section: Introductionmentioning

confidence: 99%

High Doses of Topical Amitriptyline in Neuropathic Pain: Two Cases and Literature Review

Kopsky¹,

Hesselink²

2011

Pain Practice

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“…Here, we studied two types of chronic acquired polyneuropathies whose diagnosis can be challenging, chronic inflammatory demyelinating polyneuropathy (CIDP) and chronic idiopathic axonal polyneuropathy (CIAP). The distinction is important since specific treatment options are available for CIDP [3], whereas there is none of proven efficacy for CIAP [4].…”

Section: Introductionmentioning

confidence: 99%

Nodes of Ranvier and Paranodes in Chronic Acquired Neuropathies

et al. 2011

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Chronic acquired neuropathies of unknown origin are classified as chronic inflammatory demyelinating polyneuropathies (CIDP) and chronic idiopathic axonal polyneuropathies (CIAP). The diagnosis can be very difficult, although it has important therapeutic implications since CIDP can be improved by immunomodulating treatment. The aim of this study was to examine the possible abnormalities of nodal and paranodal regions in these two types of neuropathies. Longitudinal sections of superficial peroneal nerves were obtained from biopsy material from 12 patients with CIDP and 10 patients with CIAP and studied by immunofluorescence and in some cases electron microscopy. Electron microscopy revealed multiple alterations in the nodal and paranodal regions which predominated in Schwann cells in CIDP and in axons in CIAP. In CIDP paranodin/Caspr immunofluorescence was more widespread than in control nerves, extending along the axon in internodes where it appeared intense. Nodal channels Nav and KCNQ2 were less altered but were also detected in the internodes. In CIAP paranodes, paranodin labeling was irregular and/or decreased. To test the consequences of acquired primary Schwann cells alteration on axonal proteins, we used a mouse model based on induced deletion of the transcription factor Krox-20 gene. In the demyelinated sciatic nerves of these mice we observed alterations similar to those found in CIDP by immunofluorescence, and immunoblotting demonstrated increased levels of paranodin. Finally we examined whether the alterations in paranodin immunoreactivity could have a diagnosis value. In a sample of 16 biopsies, the study of paranodin immunofluorescence by blind evaluators led to correct diagnosis in 70±4% of the cases. This study characterizes for the first time the abnormalities of nodes of Ranvier in CIAP and CIDP, and the altered expression and distribution of nodal and paranodal proteins. Marked differences were observed between CIDP and CIAP and the alterations in paranodin immunofluorescence may be an interesting tool for their differential diagnosis.

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“…NRS score reductions percent (ΔNRS%) were quantified by (3,4). Many patients with CIAP suffer from neuropathic pain (5), which is managed using several oral medications (e.g., pregabalin, gabapentin, amitriptyline, and palmitoylethanolamide) and modalities (6,7). However, despite these treatments, pain persists in some patients.…”

Section: Outcome Measuresmentioning

confidence: 99%

The Effect of Caudal Epidural Pulsed Radiofrequency Stimulation in Patients with Refractory Chronic Idiopathic Axonal Polyneuropathy

Lee

Chang

2018

Pain Phys

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Background: Many patients with chronic idiopathic axonal polyneuropathy (CIAP) suffer from neuropathic pain, which is managed using several oral medications and modalities. However, despite these treatments, pain persists in some patients. Objective: In the clinical field, clinicians frequently meet patients with neuropathic pain caused by CIAP. The authors investigated the effect of caudal epidural pulsed radiofrequency (PRF) for the management of CIAP-induced refractory neuropathic pain. Study Design: This is a prospective study. Setting: The outpatient clinic of a single academic medical center in Korea Methods: Twenty patients with neuropathic pain and a diagnosis of refractory CIAP were recruited. For PRF stimulation, a 22-gauge cannula was inserted into the epidural space through the sacral hiatus under fluoroscopic guidance. PRF stimulation was administered once at 5 Hz with a 5-ms pulse width for 600 seconds at 55 V. The effect of stimulation was evaluated using a numeric rating scale (NRS) at 2 weeks and 1, 2, and 3 months after the procedure. Successful pain relief was defined as a reduction in the NRS score of ≥ 50% as compared with the score prior to treatment. In addition, at 3 months after treatment, patient satisfaction levels were examined; patients that reported “very good” (score = 7) or “good” (score = 6) results were considered to be satisfied with the procedure. Results: Neuropathic pain was significantly reduced at 2 weeks and at 1, 2, and 3 months followup after PRF (P < 0.001, repeated measures one-factor analysis). In addition, at 3 months post-PRF, half of the patients achieved a successful response (≥ 50% pain reduction) and were satisfied with treatment results. Limitations: A small number of patients were recruited, and we did not perform long-term follow-up. Conclusion: Caudal epidural PRF may be a good treatment option for managing neuropathic pain induced by CIAP, especially when pain is unresponsive to oral medications. Key words: Pulsed radiofrequency, chronic idiopathic axonal neuropathy, caudal epidural stimulation, neuropathic pain chronic pain, refractory pain

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Drug therapy for chronic idiopathic axonal polyneuropathy

Cited by 9 publications

References 102 publications

High Doses of Topical Amitriptyline in Neuropathic Pain: Two Cases and Literature Review

High Doses of Topical Amitriptyline in Neuropathic Pain: Two Cases and Literature Review

Nodes of Ranvier and Paranodes in Chronic Acquired Neuropathies

The Effect of Caudal Epidural Pulsed Radiofrequency Stimulation in Patients with Refractory Chronic Idiopathic Axonal Polyneuropathy

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