Post-ischaemic paraesthesia in pellagrins.

Abstract

SUMMARY A quantitative assessment ofpost-ischaemic paraesthesiae has been made in 50 pellagrins and 20 healthy identical controls. The results show a highly significant diminution of the paraesthetic response in pellagrins. In pellagrins having peripheral neuropathy the depression of paraesthesiae was more marked than in those without peripheral neuropathy. There was no consistent relationship between severity of peripheral neuropathy and degree of depression of paraesthetic response.Post-ischaemic paraesthesia has been used in the evaluation of peripheral nerve function in many diseases including intoxication, vitamin deficiencies, alcoholism, malignant disease, and diabetes mellitus (Poole, 1956b); chronic liver disease (Seneviratne and Peiris, 1970); uraemia (Christensen and 0rskov, 1969); and motor-neurone disease (Shahani and Russell, 1969). However, in pellagra. where neurological manifestations are quite common, no such study is available. MethodsFifty patients with pellagra admitted to the General Hospital, Udaipur and 20 healthy control subjects of identical age and sex were studied. The diagnosis of pellagra was made on clinical grounds and was confirmed by decreased 24 hour urinary excretion of N' methyl nicotinamide (less than 2 mg). The N' methyl nicotinamide was estimated by the technique of Sarett (1943 In all subjects vascular occlusion was effected by rapid inflation of an ordinary sphygmomanometer cuff to a pressure of 60 mmHg above the resting systolic blood pressure. This was maintained for 20 minutes and then the cuff pressure was released. All subjects were instructed at the beginning of the vascular occlusion to report the time of onset, nature, and time of cessation of any subjective sensations that they experienced during the ischaemic and post-ischaemic periods. During the post-ischaemic period they were reminded at regular intervals of the need to report the details of any paraesthesiae experienced, special attention being paid to the 'pins and needles' type of postischaemic paraesthesia.A quantitative assessment of the 'pins and needles' paraesthesia was made by determining a post-ischaemic paraesthesiae (PIP) index (Seneviratne et al., 1973). For calculating the PIP index a PIP score was determined depending upon the intensity of paraesthesiae as described below and then this score was multiplied by the duration in minutes of 'pins and needles' paraesthesia. The reasons for selecting 'pins and needles' paraesthesia alone for determining the PIP score were its easy recognition, constancy, reliability, and reproducibility.