1,721,092 research outputs found
Neuropathic pain and diabetes: Focus on mechanisms and potential therapeutic strategies
No full textNeuropathic pain is a challenging condition in clinical practice and a common complication in patients with diabetic neuropathy. In the last decade, several advances in the knowledge of the pathophysiological mechanisms of neuropathic pain have been achieved. Besides the mechanisms of peripheral and central sensitization involving axons, dorsal root ganglion, dorsal horn neurons, and descending modulatory pathways, the role of immune system and activated microglia and astrocytes, which can release chemokines, growth factors, nitric oxide, and nucleotides able to directly influence the neuronal electric activity, has been demonstrated. These complex mechanisms could partly explain the transition from the acute to the chronic phase of neuropathic pain and its maintenance over time. The ability of nerves to achieve a complete regeneration after injury can also influence persistence and intensity of neuropathic pain. Further important clues have come from studies demonstrating that neuropathic pain can be modulated by genetic background and that potential endogenous regulators of pain sensitivity and chronicity might be modulated by new drugs. These findings suggest that new strategies, with potential disease-modifying activity, might be available to treat chronic neuropathic pain in the near future
Recent developments in the management of peripheral neuropathy using skin biopsy = La biopsie cutanée : les progrès d’un outil diagnostique des neuropathies périphériques
No full textSkin biopsy has become a widely used tool to investigate small calibre nerve fibres in peripheral neuropathies. This technique is safe, minimally invasive, painless, easy to perform, and cheap. It provides diagnostic information in patients with small fibre neuropathy in whom routine neurophysiological tests are commonly normal. Moreover, it allows investigating the innervation of sweat glands, thus giving information on the autonomic nervous system. Biopsy of the hairy skin is used to investigate unmyelinated and small myelinated fibres, whereas biopsy of the glabrous skin can be taken to examine large myelinated fibres. The applications of skin biopsy for diagnostic and research purposes cover the spectrum of peripheral nervous system diseases, from painful axonal neuropathies to sensory neuronopathies and immune-mediated and inherited demyelinated neuropathies. Finally, studies on axon regeneration in human and experimental models suggest that skin biopsy has a potential usefulness to monitor the progression of neuropathy and the efficacy of neuroprotective treatments.La biopsie cutanée est largement utilisée pour dépister les neuropathies périphériques à petites fibres. Cette technique peu invasive et indolore est facile à réaliser et peu coûteuse. Elle permet le diagnostic chez les patients présentant une neuropathie à petites fibres où les résultats obtenus par l’ENMG peuvent être normaux. Par ailleurs, elle permet l’étude de l’innervation des glandes sudoripares et fournit ainsi des informations sur le système nerveux autonome. La biopsie cutanée en zone pileuse permet l’étude des fibres amyéliniques et des petites fibres myélinisées, tandis que la biopsie en zone glabre renseigne sur les grandes fibres myélinisées. Les applications cliniques et celles de recherche sont nombreuses pour l’ensemble des neuropathies périphériques, allant des neuropathies axonales douloureuses aux neuronopathies sensitives et aux neuropathies démyélinisantes dysimmunitaires et héréditaires. Enfin, l’étude de la régénération axonale chez l’homme et chez l’animal suggère que la biopsie cutanée peut contribuer au suivi de l’évolution des neuropathies et de l’efficacité des traitements neuroprotecteurs
Guillain-Barré syndrome following measles infection : case report and review of the literature
No full textSkin biopsy in painful and immune-mediated neuropathies
No full textStarting from the original studies of the 19th century, this review covers some of the advances achieved over the last 15 years since skin biopsy has become a diagnostic tool for neurologists. In a relatively short period of time, focused works demonstrated the correlation between the loss of intraepidermal nerve fibers (IENF) and symptoms and signs of small fiber neuropathy (SFN), and provided standardized protocols for nerve morphometry as well as normative reference values to be used in clinical practice. This contributed to the definition of the diagnostic criteria for SFN that is now recognized as a distinct nosologic entity. The relationship between IENF degeneration and neuropathic pain led to the recent discovery that SFN can be caused by mutations in sodium channels, providing evidence for a new diagnostic approach to the etiology of the disease in patients. The presence of myelinated nerve fibers in the dermis prompted studies focused on demyelinating neuropathies of genetic and immune-mediated origin. Specific changes in dermal myelinated nerves have been described suggesting a potential role for skin biopsy also in these fields. Finally, studies on the sequence of events occurring after nerve degeneration in experimental models and patients with chronic neuropathies allowed to understand better the ability of skin nerves to regenerate and the reasons for its failure, providing important hints for the use of skin biopsy as an outcome measure in clinical practice and neuroprotective trials
Cephalic tetanus presenting with incomplete Bell's palsy
No full textWe present a case of cephalic tetanus in a 60-year old man, whose onset was accompanied by an unusual and incomplete palsy of the muscles supplied by the upper branch of the seventh cranial nerve. Seven days before the appearance of incomplete Bell's palsy, the patient had suffered a slight superficial wound to his forehead on the same side. Seventeen days after the injury, there was evidence of generalized tetanus
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No full textSkin biopsy: a new diagnostic tool for autonomic dysfunctions in Parkinson's disease
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