Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Abstract

Background: Beri Beri is still seen in Asian countries due to the large-scale consumption of thiamine depleted polished rice. Thiamine deficiency related disorders are increasingly being reported from Kashmir from last two decades. Specifically, a sensorimotor axonal neuropathy occasionally develops from thiamine deficiency and may occur even without associated Wernicke’s encephalopathy.Methods: This study is a retrospective observational study. All peripartum females referred to our departments from January 2016 to December 2017 with complaints of generalized weakness and or sensory symptoms in form of paresthesias /numbness in limbs were enrolled. Clinical features, electrophysiological features, course in hospital and response to treatment in suspected thiamine deficiency related neuropathy patients were recorded.Results: Forty-three cases were included in the study. Twenty-nine patients were suspected to have nutritional neuropathy because of thiamine deficiency at the time of admission. Out of these 27 showed improvement on treatment with thiamine.Conclusions: Thiamine responsive neuropathy is common in peripartum women of this part of world. Diagnosis is usually made clinically, in at risk individuals presenting with characteristic clinical features.

Thiamine deficiency disorders: a clinical perspective

“…In a retrospective hospital‐based study in Kashmir, of 27 peripartum women with a history of hyperemesis gravidarum or nausea with poor intake and thiamine deficiency–related peripheral neuropathy, 19 patients improved with intravenous thiamine doses of 200–500 mg three times daily for 3–5 days followed by oral thiamine. 69 A positive response to thiamine was assessed by subjective and objective improvement of weakness and amelioration of edema. Improvements in symptoms were noted within 24–72 h of thiamine administration.…”

Thiamine deficiency in pregnancy and lactation: implications and present perspectives

“…Additionally, in various countries, the high carbohydrate staple diet, consumption of washed milled rice, postpartum dietary restrictions and consumption of thiaminase-containing foods like pickles, tea etc. further increase the demand for thiamine in the body ( 28 , 30 , 81 ).…”

“…A study by Dias et al conducted among women in a rural, low-income community in Brazil found that thiamine diphosphate levels were inversely correlated with the psychiatric parameters in the Hamilton Anxiety Scale (HAMA) and the Beck Depression Inventory (BDI) tests ( 132 ). A retrospective observational study by Hilal Ahmad et al among peripartum women of Kashmir reported that thiamine-responsive polyneuropathy was present in 27 out of 43 pregnant/puerperium women in Kashmir who presented with weakness and sensory complaints such as numbness or paraesthesia ( 28 ). Hegde et al presented a case series of rare neurological and cardio-pulmonary manifestations of thiamine deficiency in five women during pregnancy and lactation.…”

“…(25,26). Thiamine deficiency during pregnancy and lactation has been reported in Southeast Asia (27)(28)(29) and sub-Saharan Africa (30). Infantile beriberi has also been recognized in several regions of central and Southeast Asia, especially in Myanmar, Laos, and Cambodia (26,(31)(32)(33)(34).…”

The Role of Dietary Nutrients in Peripheral Nerve Regeneration

“…Thiamine deficiency is the main cause of Beri Beri disease, which is a sensorimotor axonal neuropathy that is characterised by generalised weakness usually accompanied by sensory symptoms as paresthesias or limb numbness. Patients subjected to thiamine treatment either via oral consumption or injections have shown improvements in Beri Beri symptoms [142].…”